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General NPI Number Information
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NPI Number | 1447452586
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Entity Type | Organization
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Legal Business Name | MALAMA HALE INC.
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5105 SLOAN WAY
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City | UNION CITY
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State | CA
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Zip | 94587-5560
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Country | US
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Telephone | 650-703-5703
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Fax | 510-324-3566
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Provider Business Mailing Address
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Address Line | 5105 SLOAN WAY
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City | UNION CITY
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State | CA
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Zip | 94587-5560
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Country | US
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Telephone | 650-703-5703
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Fax | 510-324-3566
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Authorized Official
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Title or Position | QMRP
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Name | MR. PACIFICO T. RUIZ
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Credential | ADMINISTRATOR
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Telephone | 650-703-5703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State | CA
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