Provider Demographics
NPI:1003355173
Name:OHANA SERVICE AGENCY
Entity Type:Organization
Organization Name:OHANA SERVICE AGENCY
Other - Org Name:OHANA GROUP HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/ MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HASKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-231-3397
Mailing Address - Street 1:8600 RALSTON RD # L103
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-2351
Mailing Address - Country:US
Mailing Address - Phone:208-610-9268
Mailing Address - Fax:720-603-9311
Practice Address - Street 1:8600 RALSTON RD # L103
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002
Practice Address - Country:US
Practice Address - Phone:208-610-9268
Practice Address - Fax:720-603-9311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO050467253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency