Provider Demographics
NPI:1225659857
Name:HANA PONO WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:HANA PONO WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-679-6542
Mailing Address - Street 1:45-167 KEANA RD
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2317
Mailing Address - Country:US
Mailing Address - Phone:808-679-6542
Mailing Address - Fax:808-263-4241
Practice Address - Street 1:2 AARONA PL STE 202
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2545
Practice Address - Country:US
Practice Address - Phone:808-679-6542
Practice Address - Fax:808-235-3568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-05
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy