Healthcare Provider Details

I. General information

NPI: 1831812874
Provider Name (Legal Business Name): OHANA SUPPORTIVE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 ORCHARD AVE STE B4
GRAND JUNCTION CO
81501-2147
US

IV. Provider business mailing address

104 ORCHARD AVE STE B4
GRAND JUNCTION CO
81501-2147
US

V. Phone/Fax

Practice location:
  • Phone: 970-985-2197
  • Fax:
Mailing address:
  • Phone: 970-985-2197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: KEHAU MARTINEZ
Title or Position: DIRECTOR
Credential:
Phone: 970-985-2197