Healthcare Provider Details

I. General information

NPI: 1538157847
Provider Name (Legal Business Name): OWAKIHI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CONCORD EXCHANGE N
SOUTH SAINT PAUL MN
55075-1104
US

IV. Provider business mailing address

201 CONCORD EXCHANGE N
SOUTH SAINT PAUL MN
55075-1104
US

V. Phone/Fax

Practice location:
  • Phone: 651-451-2889
  • Fax: 651-451-5955
Mailing address:
  • Phone: 651-451-2889
  • Fax: 651-451-5955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number8002603RS
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number8024332RS
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL J MOHRBACHER
Title or Position: PRESIDENT
Credential:
Phone: 651-451-2889