Healthcare Provider Details

I. General information

NPI: 1164941464
Provider Name (Legal Business Name): HALE HAU'OLI HAWAII
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 09/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1247 KAAHUMANU ST STE 207
AIEA HI
96701-5392
US

IV. Provider business mailing address

94-280 KIKIULA LOOP
MILILANI HI
96789-2136
US

V. Phone/Fax

Practice location:
  • Phone: 808-798-8706
  • Fax: 808-691-9027
Mailing address:
  • Phone: 808-292-4665
  • Fax: 808-691-9027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1-0615
License Number StateHI

VIII. Authorized Official

Name: MS. KATHLEEN WYATT
Title or Position: PRESIDENT
Credential: RN
Phone: 808-798-8706