Provider Demographics
NPI:1972229607
Name:EXECUTIVE AND PROFESSIONAL SERVICES LLC
Entity type:Organization
Organization Name:EXECUTIVE AND PROFESSIONAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-652-2684
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:KALAHEO
Mailing Address - State:HI
Mailing Address - Zip Code:96741-0488
Mailing Address - Country:US
Mailing Address - Phone:808-652-2684
Mailing Address - Fax:
Practice Address - Street 1:4432 PAPALINA RD
Practice Address - Street 2:
Practice Address - City:KALAHEO
Practice Address - State:HI
Practice Address - Zip Code:96741
Practice Address - Country:US
Practice Address - Phone:808-652-2684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty