Healthcare Provider Details

I. General information

NPI: 1376081182
Provider Name (Legal Business Name): OHANA FAMILY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 11/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12817 APPALOOSA AVE
WELLINGTON CO
80549-1946
US

IV. Provider business mailing address

12817 APPALOOSA AVE
WELLINGTON CO
80549-1946
US

V. Phone/Fax

Practice location:
  • Phone: 970-999-2350
  • Fax:
Mailing address:
  • Phone: 970-999-2350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY SALEM
Title or Position: PRESIDENT
Credential:
Phone: 970-999-2350