Provider Demographics
NPI:1699484089
Name:INTEGRATED HEALTH HAWAII, LLC
Entity type:Organization
Organization Name:INTEGRATED HEALTH HAWAII, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIMOMURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-942-1852
Mailing Address - Street 1:1357 KAPIOLANI BLVD STE 1430
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4509
Mailing Address - Country:US
Mailing Address - Phone:808-657-6473
Mailing Address - Fax:808-930-9874
Practice Address - Street 1:1357 KAPIOLANI BLVD STE 1430
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4509
Practice Address - Country:US
Practice Address - Phone:808-657-6473
Practice Address - Fax:808-930-9874
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PMAG CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-15
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No251B00000XAgenciesCase Management