Provider Demographics
NPI:1376156570
Name:PALOLO CHINESE HOME WELLNESS PROGRAM
Entity Type:Organization
Organization Name:PALOLO CHINESE HOME WELLNESS PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKAYAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-748-4901
Mailing Address - Street 1:2459 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-3098
Mailing Address - Country:US
Mailing Address - Phone:808-564-5228
Mailing Address - Fax:808-564-5294
Practice Address - Street 1:2459 10TH AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-3098
Practice Address - Country:US
Practice Address - Phone:808-564-5228
Practice Address - Fax:808-564-5294
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PALOLO CHINESE HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care