Healthcare Provider Details

I. General information

NPI: 1306614805
Provider Name (Legal Business Name): THE RESILIENT LIFE ORGANZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 KAMEHAMEHA HWY UNIT 962
PEARL CITY HI
96782-5042
US

IV. Provider business mailing address

PO BOX 962
PEARL CITY HI
96782-0962
US

V. Phone/Fax

Practice location:
  • Phone: 808-494-1528
  • Fax: 808-210-6095
Mailing address:
  • Phone: 808-392-3330
  • Fax: 808-210-6095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

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