Healthcare Provider Details

I. General information

NPI: 1346814621
Provider Name (Legal Business Name): OHANA HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 MASON AVE APT 633
DAYTONA BEACH FL
32117-5129
US

IV. Provider business mailing address

1717 MASON AVE
DAYTONA BEACH FL
32117-5124
US

V. Phone/Fax

Practice location:
  • Phone: 386-999-1311
  • Fax:
Mailing address:
  • Phone: 386-999-1311
  • 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: BENAI ROBINSON
Title or Position: OWNER
Credential:
Phone: 386-999-1311