Healthcare Provider Details

I. General information

NPI: 1003412214
Provider Name (Legal Business Name): OHANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

647 W HIGHWAY 80 STE 2
SOMERSET KY
42503-2897
US

IV. Provider business mailing address

105 LAY ST
BARBOURVILLE KY
40906-1009
US

V. Phone/Fax

Practice location:
  • Phone: 606-425-4712
  • Fax:
Mailing address:
  • Phone: 606-260-2530
  • Fax:

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: KAELA PATTERSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 606-425-4712