Provider Demographics
NPI:1962773176
Name:UNITED CEREBRAL PALSY ASSOCIATION OF HAWAII
Entity type:Organization
Organization Name:UNITED CEREBRAL PALSY ASSOCIATION OF HAWAII
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOUTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-532-6744
Mailing Address - Street 1:414 KUWILI ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-5362
Mailing Address - Country:US
Mailing Address - Phone:808-532-6744
Mailing Address - Fax:808-532-6747
Practice Address - Street 1:414 KUWILI ST
Practice Address - Street 2:SUITE 105
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5362
Practice Address - Country:US
Practice Address - Phone:808-532-6744
Practice Address - Fax:808-532-6747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI64643201Medicaid