Healthcare Provider Details

I. General information

NPI: 1326760158
Provider Name (Legal Business Name): OHANA HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 VICTOR AVE
REDDING CA
96002-1450
US

IV. Provider business mailing address

3075 VICTOR AVE
REDDING CA
96002-1450
US

V. Phone/Fax

Practice location:
  • Phone: 480-404-3306
  • Fax:
Mailing address:
  • Phone: 530-230-5730
  • Fax: 530-230-5730

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: ROSELYN MANALO MCCORMACK
Title or Position: DIRECTOR OF PATIENT CARE DESIGNEE
Credential:
Phone: 480-404-3306