Healthcare Provider Details

I. General information

NPI: 1467014563
Provider Name (Legal Business Name): OHANA BEHAVIORAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4221 E RAY RD APT 2083
PHOENIX AZ
85044-0604
US

IV. Provider business mailing address

4221 E RAY RD APT 2083
PHOENIX AZ
85044-0604
US

V. Phone/Fax

Practice location:
  • Phone: 619-823-9444
  • Fax:
Mailing address:
  • Phone: 619-823-9444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KIMO HENSON
Title or Position: OWNER
Credential:
Phone: 619-823-9444