Healthcare Provider Details

I. General information

NPI: 1295580967
Provider Name (Legal Business Name): THE RESILIENT LIFE ORGANZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1962 WAIMANO HOME RD
PEARL CITY HI
96782-1468
US

IV. Provider business mailing address

PO BOX 962
PEARL CITY HI
96782-0962
US

V. Phone/Fax

Practice location:
  • Phone: 808-392-3330
  • Fax: 808-210-6095
Mailing address:
  • Phone: 808-392-3330
  • Fax: 808-210-6095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ALICIA FU
Title or Position: OWNER
Credential:
Phone: 808-392-3330