Provider Demographics
NPI:1215533492
Name:HALE MAHAOLU
Entity Type:Organization
Organization Name:HALE MAHAOLU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:IGNACIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-873-0521
Mailing Address - Street 1:200 HINA AVE
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-1821
Mailing Address - Country:US
Mailing Address - Phone:808-873-0521
Mailing Address - Fax:
Practice Address - Street 1:200 HINA AVE
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-1821
Practice Address - Country:US
Practice Address - Phone:808-873-0521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI800714Medicaid