Healthcare Provider Details

I. General information

NPI: 1386005924
Provider Name (Legal Business Name): BOCHA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 S KIHEI RD STE O735
KIHEI HI
96753-5220
US

IV. Provider business mailing address

1215 S KIHEI RD STE O735
KIHEI HI
96753-5220
US

V. Phone/Fax

Practice location:
  • Phone: 808-446-2712
  • Fax:
Mailing address:
  • Phone: 808-446-2712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberBA63
License Number StateHI

VIII. Authorized Official

Name: BEAU LAUGHLIN
Title or Position: OWNER
Credential: LBA
Phone: 808-446-2712