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General NPI Number Information
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NPI Number | 1700595063
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Entity Type | Organization
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Legal Business Name | MANA SOBER LIVING
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Dates
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Enumeration Date | 11/15/2022
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Last Update Date | 01/15/2026
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Provider Practice Location Address
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Address Line | 834 WAILUPE DR
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City | WAILUKU
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State | HI
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Zip | 96793-9644
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Country | US
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Telephone | 808-867-9268
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1858
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City | WAILUKU
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State | HI
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Zip | 96793-6858
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Country | US
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Telephone | 808-867-9268
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | GREGORY STRUVE
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Credential |
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Telephone | 808-867-9268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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