Provider Demographics
NPI:1447311485
Name:THE QUEENS COMMUNITY BASED PROGRAMS
Entity type:Organization
Organization Name:THE QUEENS COMMUNITY BASED PROGRAMS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:RIX
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:808-547-4329
Mailing Address - Street 1:1301 PUNCHBOWL STREET
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2499
Mailing Address - Country:US
Mailing Address - Phone:808-547-4628
Mailing Address - Fax:808-547-4625
Practice Address - Street 1:838 SOUTH BERETANIA STREET
Practice Address - Street 2:#308
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-4625
Practice Address - Country:US
Practice Address - Phone:808-547-4628
Practice Address - Fax:808-547-4625
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE QUEENS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-13
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHCBS0509251B00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI50871503Medicaid
HI52017301Medicaid
HI50871502Medicaid
HI50871501Medicaid