Healthcare Provider Details

I. General information

NPI: 1992500656
Provider Name (Legal Business Name): OHANA ADULT CARE HOME 2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8207 W CACTUS RD
PEORIA AZ
85381-5215
US

IV. Provider business mailing address

8207 W CACTUS RD
PEORIA AZ
85381-5215
US

V. Phone/Fax

Practice location:
  • Phone: 602-510-9422
  • Fax:
Mailing address:
  • Phone: 602-510-9422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: CARL CANDLER JR.
Title or Position: OWNER
Credential:
Phone: 602-510-9422