Healthcare Provider Details

I. General information

NPI: 1336870708
Provider Name (Legal Business Name): OHANA ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8602 N 22ND ST
TAMPA FL
33604-2104
US

IV. Provider business mailing address

8090 50TH AVE N
SAINT PETERSBURG FL
33709-2232
US

V. Phone/Fax

Practice location:
  • Phone: 727-851-3830
  • Fax:
Mailing address:
  • Phone: 727-851-3830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: JAKAYLA L MCKENZIE
Title or Position: OWNER
Credential:
Phone: 727-851-3830