Healthcare Provider Details

I. General information

NPI: 1194544015
Provider Name (Legal Business Name): OHANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 10/08/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 E NORTH AVE UPPR LEVEL
BALTIMORE MD
21202-5905
US

IV. Provider business mailing address

1635 EDMONDSON AVE APT 2
BALTIMORE MD
21223-1264
US

V. Phone/Fax

Practice location:
  • Phone: 443-835-4821
  • Fax: 443-869-2277
Mailing address:
  • Phone: 443-835-4821
  • Fax: 443-869-2277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ZENOBIA EDISON
Title or Position: CEO
Credential:
Phone: 443-570-0421