Healthcare Provider Details

I. General information

NPI: 1538437645
Provider Name (Legal Business Name): OHANA SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-126 KAUPU PL
WAIPAHU HI
96797-3800
US

IV. Provider business mailing address

94-126 KAUPU PL
WAIPAHU HI
96797-3800
US

V. Phone/Fax

Practice location:
  • Phone: 808-682-7384
  • Fax:
Mailing address:
  • Phone: 808-682-7384
  • 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

VIII. Authorized Official

Name: MS. JULIA SHIMASAKI
Title or Position: CEO
Credential:
Phone: 808-682-7384