Healthcare Provider Details

I. General information

NPI: 1235132242
Provider Name (Legal Business Name): HALE MAKUA HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 E MAIN ST
WAILUKU HI
96793-1958
US

IV. Provider business mailing address

1520 E MAIN ST
WAILUKU HI
96793-1958
US

V. Phone/Fax

Practice location:
  • Phone: 808-244-3661
  • Fax: 808-244-5470
Mailing address:
  • Phone: 808-244-3661
  • Fax: 808-244-5470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA-3
License Number StateHI

VIII. Authorized Official

Name: WESLEY LO
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 808-877-2761