Healthcare Provider Details

I. General information

NPI: 1588171284
Provider Name (Legal Business Name): MALAMA OLA HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2018
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1783 PIIKEA ST
HONOLULU HI
96818-1849
US

IV. Provider business mailing address

PO BOX 30273
HONOLULU HI
96820-0273
US

V. Phone/Fax

Practice location:
  • Phone: 808-543-1188
  • Fax: 808-543-1189
Mailing address:
  • Phone: 808-543-1188
  • Fax: 808-543-1189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number17-02
License Number StateHI

VIII. Authorized Official

Name: MICHAEL GREGORY DUICK
Title or Position: MEMBER
Credential: MD
Phone: 808-543-1188