Healthcare Provider Details

I. General information

NPI: 1497466064
Provider Name (Legal Business Name): OHANAS CONNECTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 06/04/2023
Certification Date: 06/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 S GLANCY ST
SWANSBORO NC
28584-9656
US

IV. Provider business mailing address

334 SONOMA RD
JACKSONVILLE NC
28546-8405
US

V. Phone/Fax

Practice location:
  • Phone: 252-503-1879
  • Fax:
Mailing address:
  • Phone: 252-503-1879
  • 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
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: SHANTESE HILLS
Title or Position: OWNER
Credential:
Phone: 252-503-1879