Healthcare Provider Details

I. General information

NPI: 1104599901
Provider Name (Legal Business Name): OHANA NAMPA OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 S EDGEWATER CIR
NAMPA ID
83686-6085
US

IV. Provider business mailing address

PO BOX 988
LAKE OSWEGO OR
97034-0109
US

V. Phone/Fax

Practice location:
  • Phone: 503-250-3825
  • Fax:
Mailing address:
  • Phone: 503-250-3825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW HILTY
Title or Position: OWNER
Credential:
Phone: 503-250-3825