Basic Information
| Provider Information | |||||||||
| NPI: | 1871936617 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | IMUA FAMILY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 161 S. WAKEA AVE. | ||||||||
| Address2: | |||||||||
| City: | KAHULUI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082447467 | ||||||||
| FaxNumber: | 8082425835 | ||||||||
| Practice Location | |||||||||
| Address1: | 161 S. WAKEA AVE. | ||||||||
| Address2: | |||||||||
| City: | KAHULUI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082447467 | ||||||||
| FaxNumber: | 8082425835 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2013 | ||||||||
| LastUpdateDate: | 09/02/2015 | ||||||||
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| AuthorizedOfficialLastName: | WONG | ||||||||
| AuthorizedOfficialFirstName: | DEAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8082447467 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 252Y00000X | Y | Agencies | Early Intervention Provider Agency |
No ID Information.