Provider Demographics
NPI:1699164780
Name:ALL ISLAND CASE MANAGEMENT CORPORATION
Entity type:Organization
Organization Name:ALL ISLAND CASE MANAGEMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:P
Authorized Official - Last Name:TALAVERA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:808-358-8964
Mailing Address - Street 1:1188 BISHOP ST
Mailing Address - Street 2:SUITE 1508
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3301
Mailing Address - Country:US
Mailing Address - Phone:808-536-7100
Mailing Address - Fax:
Practice Address - Street 1:1188 BISHOP ST
Practice Address - Street 2:SUITE 1508
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3301
Practice Address - Country:US
Practice Address - Phone:808-536-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1-000040251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI585507Medicaid