Healthcare Provider Details

I. General information

NPI: 1902516602
Provider Name (Legal Business Name): OHANA SENIOR CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 11/24/2023
Certification Date: 11/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1454 MIDDLE ST
HONOLULU HI
96819-2501
US

IV. Provider business mailing address

1454 MIDDLE ST
HONOLULU HI
96819-2501
US

V. Phone/Fax

Practice location:
  • Phone: 808-913-2067
  • Fax: 808-913-2067
Mailing address:
  • Phone: 808-913-2067
  • Fax: 808-913-2067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: ANGEL LEAH BUENO AGBISIT
Title or Position: OWNER/MANAGING MEMBER
Credential:
Phone: 808-913-2067