Healthcare Provider Details

I. General information

NPI: 1932960374
Provider Name (Legal Business Name): HE ALA HOU O KE OLA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 PUUHALE RD
HONOLULU HI
96819-3241
US

IV. Provider business mailing address

531 PUUHALE RD
HONOLULU HI
96819-3241
US

V. Phone/Fax

Practice location:
  • Phone: 808-807-0770
  • Fax:
Mailing address:
  • Phone: 808-807-0770
  • Fax: 808-444-0770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. BENDY SYSOMBOUN
Title or Position: OPERATIONS DIRECTOR
Credential:
Phone: 702-723-6390