MEDICARE: OHANA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	276400000X	Substance Use Disorder Rehabilitation Hospital Unit
4	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1194544015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHANA, LLC

Provider Business Mailing Address
First Line	:	1635 EDMONDSON AVE APT 2
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21223-1264
Country	:	US
Telephone Number	:	443-835-4821
Fax Number	:	443-869-2277

Provider Business Practice Location Address
First Line	:	23 E NORTH AVE UPPER LEVEL ONE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21202-5905
Country	:	US
Telephone Number	:	443-835-4821
Fax Number	:	443-869-2277

Authorized Official
Title or Position	:	CEO
Name	:	ZENOBIA EDISON
Credential	:
Telephone Number	:	443-570-0421

Provider Enumeration Date	:	10/08/2024
Last Update Date	:	03/18/2026

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Directions to “OHANA, LLC ” Practice Location

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