Basic Information
| Provider Information | |||||||||
| NPI: | 1205838539 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAUI YOUTH AND FAMILY SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 790006 | ||||||||
| Address2: | |||||||||
| City: | PAIA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967790006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085798414 | ||||||||
| FaxNumber: | 8085798426 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 IKE DR | ||||||||
| Address2: | |||||||||
| City: | MAKAWAO | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967689718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085798414 | ||||||||
| FaxNumber: | 8085798426 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GNAZZO | ||||||||
| AuthorizedOfficialFirstName: | GAIL | ||||||||
| AuthorizedOfficialMiddleName: | PATRICIA | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8085798414 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | QCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251V00000X | X | Agencies | Voluntary or Charitable | 3245S0500X | 51STF | HI | X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children | 3245S0500X | 60STF | HI | X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children | 322D00000X | 12TLP | HI | X | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | 322D00000X | 74STF | HI | X | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children |
ID Information
| ID | Type | State | Issuer | Description | 0000245324 | 01 | HI | HMSA BLUE CROSS BLUE SHIE | OTHER |