Provider Demographics
NPI:1306141809
Name:ALII COMMUNITY CARE, INC.
Entity type:Organization
Organization Name:ALII COMMUNITY CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-331-0777
Mailing Address - Street 1:75-5759 KUAKINI HWY
Mailing Address - Street 2:SUITE 208
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1726
Mailing Address - Country:US
Mailing Address - Phone:808-331-0777
Mailing Address - Fax:808-331-8682
Practice Address - Street 1:81-956 HALEKII ST
Practice Address - Street 2:SUITE 2
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-8104
Practice Address - Country:US
Practice Address - Phone:808-323-2110
Practice Address - Fax:808-323-2119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI6474990003Medicare NSC