Healthcare Provider Details

I. General information

NPI: 1922427129
Provider Name (Legal Business Name): POAILANI, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

553 KAWAINUI ST
KAILUA HI
96734-2408
US

IV. Provider business mailing address

970 N KALAHEO AVE STE A102
KAILUA HI
96734-1866
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ABBY PAREDES
Title or Position: ED
Credential:
Phone: 808-263-3500