| Jea | |
|
543885 Akoni Pule Hwy 211-d Kapaau HI 96755 | |
| (808) 889-6200 | |
| Not Available |
| Full Name | Jea |
|---|---|
| Speciality | Psychologist |
| Location | 543885 Akoni Pule Hwy, Kapaau, Hawaii |
| Authorized Official Name and Position | James F Efstation (PRESIDENT/OWNER) |
| Authorized Official Contact | 8088951370 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jea Po Box 115 Kapaau HI 96755-0115 Ph: (808) 895-1370 | Jea 543885 Akoni Pule Hwy 211-d Kapaau HI 96755 Ph: (808) 889-6200 |
| NPI Number | 1407166366 |
|---|---|
| Provider Enumeration Date | 10/13/2010 |
| Last Update Date | 10/13/2010 |
| Medicare PECOS PAC ID | 6002704996 |
|---|---|
| Medicare Enrollment ID | O20040310001174 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407166366 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 769 (Hawaii) | Primary |
| Provider Name | James F Efstation |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1104881283 PECOS PAC ID: 6608765599 Enrollment ID: I20101118001099 |
Sacred Life Wellness Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 53-4411 Akoni Pule Hwy, Kapaau, HI 96755 Phone: 808-209-2263 Fax: 833-402-1821 |