Provider Demographics
NPI:1003274325
Name:MALAMA PONO HEALTH SERVICES
Entity Type:Organization
Organization Name:MALAMA PONO HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MISTEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY-MYRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-246-9577
Mailing Address - Street 1:4366 KUKUI GROVE ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-2006
Mailing Address - Country:US
Mailing Address - Phone:808-246-9577
Mailing Address - Fax:808-246-9588
Practice Address - Street 1:4366 KUKUI GROVE ST
Practice Address - Street 2:SUITE 207
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-2006
Practice Address - Country:US
Practice Address - Phone:808-246-9577
Practice Address - Fax:808-246-9588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare