Provider Demographics
NPI:1235132242
Name:HALE MAKUA HEALTH SERVICES
Entity Type:Organization
Organization Name:HALE MAKUA HEALTH SERVICES
Other - Org Name:HALE MAKUA HOME HEALTH AGENCY
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-877-2761
Mailing Address - Street 1:1520 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1958
Mailing Address - Country:US
Mailing Address - Phone:808-244-3661
Mailing Address - Fax:808-244-5470
Practice Address - Street 1:1520 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1958
Practice Address - Country:US
Practice Address - Phone:808-244-3661
Practice Address - Fax:808-244-5470
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HALE MAKUA HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHHA-3251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI127003OtherPROVIDER NUMBER
HI127003OtherPROVIDER NUMBER
HI127003Medicare Oscar/Certification