Provider Demographics
NPI:1164998506
Name:KOKUA CO LLC
Entity Type:Organization
Organization Name:KOKUA CO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEVERINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-618-2319
Mailing Address - Street 1:5401 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4431
Mailing Address - Country:US
Mailing Address - Phone:877-302-5022
Mailing Address - Fax:
Practice Address - Street 1:5401 W 9TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4431
Practice Address - Country:US
Practice Address - Phone:877-302-5022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children