Healthcare Provider Details

I. General information

NPI: 1023835840
Provider Name (Legal Business Name): OHANA MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 METRO BLVD STE 550
EDINA MN
55439-1353
US

IV. Provider business mailing address

3161 RUM RIVER WAY
ANOKA MN
55303-4153
US

V. Phone/Fax

Practice location:
  • Phone: 612-568-2633
  • Fax: 612-567-4469
Mailing address:
  • Phone: 952-457-3635
  • Fax: 612-567-4469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BERNICE GYAMFI
Title or Position: PRESIDENT
Credential: C-NP
Phone: 952-457-3635