Healthcare Provider Details

I. General information

NPI: 1770570780
Provider Name (Legal Business Name): MOLOKAI OHANA HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 OKI PLACE
KAUNAKAKAI HI
96748-2040
US

IV. Provider business mailing address

PO BOX 2040
KAUNAKAKAI HI
96748-2040
US

V. Phone/Fax

Practice location:
  • Phone: 808-553-5038
  • Fax:
Mailing address:
  • Phone: 808-553-5038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: HELEN KEKALIA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 808-660-2601