Healthcare Provider Details

I. General information

NPI: 1528453669
Provider Name (Legal Business Name): POWER ON COACHING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31-631 OLD MAMALAHOA HIGHWAY
HAKALAU HI
96710
US

IV. Provider business mailing address

P.O. BOX 165
HAKALAU HI
96710
US

V. Phone/Fax

Practice location:
  • Phone: 800-775-0200
  • Fax: 808-775-9007
Mailing address:
  • Phone: 800-775-0200
  • Fax: 808-775-9007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number101-STF
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT DONOVAN SCHROEDER
Title or Position: C.E.O./PRESIDENT
Credential:
Phone: 323-702-2085