MEDICARE: MANA O NANI

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	171400000X	Health & Wellness Coach
2	172A00000X	Driver
3	174200000X	Meals Provider
4	177F00000X	Lodging Provider
5	251B00000X	Case Management Agency
6	282J00000X	Religious Nonmedical Health Care Institution
7	347C00000X	Private Vehicle
8	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1609582220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANA O NANI

Provider Business Mailing Address
First Line	:	999 E BASELINE RD APT 2208
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-1351
Country	:	US
Telephone Number	:	833-361-0040
Fax Number	:

Provider Business Practice Location Address
First Line	:	64 E BROADWAY RD
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-1353
Country	:	US
Telephone Number	:	833-361-0040
Fax Number	:

Authorized Official
Title or Position	:	CASE MANAGER/
Name	:	MS. DIANA M URIBE
Credential	:
Telephone Number	:	833-361-0040

Provider Enumeration Date	:	01/26/2023
Last Update Date	:	01/26/2023

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Directions to “MANA O NANI ” Practice Location

Language	Start Address	Practice Location

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