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General NPI Number Information
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NPI Number | 1720374374
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Entity Type | Organization
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Legal Business Name | O'HANA HERITAGE FOUNDATION INC
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Dates
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Enumeration Date | 06/22/2011
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Last Update Date | 10/23/2015
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Provider Practice Location Address
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Address Line | 53131 QUINCE RD
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City | SOUTH BEND
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State | IN
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Zip | 46628-9691
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Country | US
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Telephone | 574-235-8899
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Fax | 574-235-8897
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Provider Business Mailing Address
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Address Line | 53131 QUINCE RD
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City | SOUTH BEND
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State | IN
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Zip | 46628-9691
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Country | US
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Telephone | 574-235-8899
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Fax | 574-235-8897
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/CEO
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Name | TIEAL C. BISHOP
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Credential |
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Telephone | 574-315-6283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 284300000X
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Taxonomy Name | Special Hospital
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License Number | 11-012157-1
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License Number State | IN
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