Healthcare Provider Details

I. General information

NPI: 1093671554
Provider Name (Legal Business Name): OHANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 EDMONDSON AVE APT 2
BALTIMORE MD
21223-1264
US

IV. Provider business mailing address

1635 EDMONDSON AVE APT 2
BALTIMORE MD
21223-1264
US

V. Phone/Fax

Practice location:
  • Phone: 443-570-0421
  • Fax:
Mailing address:
  • Phone: 443-570-0421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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