Basic Information
Provider Information
NPI: 1164627246
EntityType: 2
ReplacementNPI:  
OrganizationName: HALE KIPA, INC.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 615 PIIKOI ST
Address2: SUITE 203
City: HONOLULU
State: HI
PostalCode: 968143116
CountryCode: US
TelephoneNumber: 8085891829
FaxNumber: 8085892610
Practice Location
Address1: 615 PIIKOI ST
Address2: SUITE 203
City: HONOLULU
State: HI
PostalCode: 968143116
CountryCode: US
TelephoneNumber: 8085891829
FaxNumber: 8085892610
Other Information
ProviderEnumerationDate: 06/18/2007
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: PLETAN-CROSS
AuthorizedOfficialFirstName: ERNEST
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 8085891829
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
322D00000XW2005550002HIY Residential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children 

ID Information
IDTypeStateIssuerDescription
W200555000201HIHAWAII TAX IDOTHER


Home