Healthcare Provider Details

I. General information

NPI: 1871051235
Provider Name (Legal Business Name): OHANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 N SHADY LN
EUBANK KY
42567-7659
US

IV. Provider business mailing address

170 N SHADY LN
EUBANK KY
42567-7659
US

V. Phone/Fax

Practice location:
  • Phone: 606-425-2274
  • Fax: 606-802-2266
Mailing address:
  • Phone: 606-425-2274
  • Fax: 606-802-2266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. TONYA MARIE GREGORY GRAY
Title or Position: EXECUTIVE DIRECTOR
Credential: B.S. ED
Phone: 606-425-2274