Healthcare Provider Details

I. General information

NPI: 1275289407
Provider Name (Legal Business Name): LEEWARD THERAPY AND COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-1170 MIKOHU ST APT 40C
EWA BEACH HI
96706-4317
US

IV. Provider business mailing address

91-1170 MIKOHU ST APT 40C
EWA BEACH HI
96706-4317
US

V. Phone/Fax

Practice location:
  • Phone: 505-429-5731
  • Fax:
Mailing address:
  • Phone: 808-466-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TARAH N RAMOS
Title or Position: AUTHORIZED ACCOUNT MANAGER
Credential:
Phone: 808-321-5771