Healthcare Provider Details

I. General information

NPI: 1922151026
Provider Name (Legal Business Name): PO AILANI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45-567 PAHIA ROAD
KANEOHE HI
96744
US

IV. Provider business mailing address

45-567 PAHIA ROAD
KANEOHE HI
96744
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 TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberW20316842-01
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

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