Healthcare Provider Details

I. General information

NPI: 1598057275
Provider Name (Legal Business Name): PO'AILANI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 N KALAHEO AVE STE A102
KAILUA HI
96734-1868
US

IV. Provider business mailing address

970 N KALAHEO AVE STE A102
KAILUA HI
96734-1868
US

V. Phone/Fax

Practice location:
  • Phone: 808-263-3500
  • Fax: 808-263-3508
Mailing address:
  • Phone: 808-263-3500
  • Fax: 808-263-3508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number37
License Number StateHI

VIII. Authorized Official

Name: MRS. JANET R. PAREDES
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 808-263-3500