MEDICARE: MALAMA OLA HEALTH SERVICES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	17-02	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588171284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MALAMA OLA HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 30273
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96820-0273
Country	:	US
Telephone Number	:	808-543-1188
Fax Number	:	808-543-1189

Provider Business Practice Location Address
First Line	:	1783 PIIKEA ST
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96818-1849
Country	:	US
Telephone Number	:	808-543-1188
Fax Number	:	808-543-1189

Authorized Official
Title or Position	:	MEMBER
Name	:	MICHAEL GREGORY DUICK
Credential	:	MD
Telephone Number	:	808-543-1188

Provider Enumeration Date	:	01/03/2018
Last Update Date	:	02/16/2022

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Directions to “MALAMA OLA HEALTH SERVICES LLC ” Practice Location

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