Healthcare Provider Details

I. General information

NPI: 1023406709
Provider Name (Legal Business Name): OHANA CARE MAUI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2015
Last Update Date: 01/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2854 OMAOPIO RD
KULA HI
96790-8865
US

IV. Provider business mailing address

PO BOX 344
MAKAWAO HI
96768-0344
US

V. Phone/Fax

Practice location:
  • Phone: 808-344-1285
  • Fax:
Mailing address:
  • Phone: 808-344-1285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberNOT AVAILABLE
License Number StateHI

VIII. Authorized Official

Name: MRS. JESSIKA GALVEZ
Title or Position: OWNER
Credential: CNA
Phone: 808-344-1285