Provider Demographics
NPI:1104152743
Name:21ST CENTURY HEALTHCARE LLC LLC
Entity type:Organization
Organization Name:21ST CENTURY HEALTHCARE LLC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:DOROTHY
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, JD, MPH
Authorized Official - Phone:808-622-2655
Mailing Address - Street 1:302 CALIFORNIA AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-1841
Mailing Address - Country:US
Mailing Address - Phone:808-622-2655
Mailing Address - Fax:808-622-5599
Practice Address - Street 1:302 CALIFORNIA AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-1841
Practice Address - Country:US
Practice Address - Phone:808-622-2655
Practice Address - Fax:808-622-5599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-01
Last Update Date:2009-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty