Basic Information
| Provider Information | |||||||||
| NPI: | 1265073878 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JACO REHAB HONOLULU LIMITED PARTNERSHIP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 S BERETANIA ST STE 550 | ||||||||
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| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968141880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083818947 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1401 S BERETANIA ST STE 550 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968141880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083818947 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2019 | ||||||||
| LastUpdateDate: | 10/04/2019 | ||||||||
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| AuthorizedOfficialLastName: | BINSTEIN | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP/AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 7132977000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.