Provider Demographics
NPI:1104903699
Name:CASE MANAGEMENT PROFESSIONALS, INC
Entity type:Organization
Organization Name:CASE MANAGEMENT PROFESSIONALS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:D
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:808-689-1937
Mailing Address - Street 1:91-1001 KAIMALIE ST
Mailing Address - Street 2:#201
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6247
Mailing Address - Country:US
Mailing Address - Phone:808-689-1937
Mailing Address - Fax:808-689-1933
Practice Address - Street 1:91-1001 KAIMALIE ST
Practice Address - Street 2:#201
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-6247
Practice Address - Country:US
Practice Address - Phone:808-689-1937
Practice Address - Fax:808-689-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHCBS 02-3251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI506024-01Medicaid