Provider Demographics
NPI:1164941464
Name:HALE HAU'OLI HAWAII
Entity Type:Organization
Organization Name:HALE HAU'OLI HAWAII
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:808-798-8706
Mailing Address - Street 1:94-280 KIKIULA LOOP
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-2136
Mailing Address - Country:US
Mailing Address - Phone:808-292-4665
Mailing Address - Fax:808-691-9027
Practice Address - Street 1:98-1247 KAAHUMANU ST STE 207
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5392
Practice Address - Country:US
Practice Address - Phone:808-798-8706
Practice Address - Fax:808-691-9027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1-0615261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care