Healthcare Provider Details

I. General information

NPI: 1710408877
Provider Name (Legal Business Name): OHANA CAREGIVERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3091 W SANTA CRUZ AVE
QUEEN CREEK AZ
85142-3022
US

IV. Provider business mailing address

3091 W SANTA CRUZ AVE
QUEEN CREEK AZ
85142-3022
US

V. Phone/Fax

Practice location:
  • Phone: 605-228-7765
  • Fax:
Mailing address:
  • Phone: 605-228-7765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberBH5103
License Number StateAZ

VIII. Authorized Official

Name: KALLI PULLING
Title or Position: OWNER
Credential:
Phone: 605-228-7765