Provider Demographics
NPI:1073151874
Name:MAHALA'S HOPE, INC.
Entity Type:Organization
Organization Name:MAHALA'S HOPE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:ADELLE
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-904-6445
Mailing Address - Street 1:N4590 US HIGHWAY 45
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:WI
Mailing Address - Zip Code:53019-1212
Mailing Address - Country:US
Mailing Address - Phone:920-904-6445
Mailing Address - Fax:
Practice Address - Street 1:N4590 US HIGHWAY 45
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:WI
Practice Address - Zip Code:53019-1212
Practice Address - Country:US
Practice Address - Phone:920-904-6445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder