Healthcare Provider Details

I. General information

NPI: 1245779743
Provider Name (Legal Business Name): OHANA HOME CARE AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S ASHLAND AVE STE 203
GREEN BAY WI
54304-3690
US

IV. Provider business mailing address

1600 S ASHLAND AVE STE 203
GREEN BAY WI
54304-3690
US

V. Phone/Fax

Practice location:
  • Phone: 715-308-9610
  • Fax:
Mailing address:
  • Phone: 715-308-9610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: YING VANG
Title or Position: OWNER
Credential:
Phone: 715-308-9610