Provider Demographics
NPI:1417122524
Name:KE'ENA MAULIOLA NELE PAIA LLC
Entity Type:Organization
Organization Name:KE'ENA MAULIOLA NELE PAIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JD WAILUA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-RX BC
Authorized Official - Phone:808-593-7703
Mailing Address - Street 1:615 PIIKOI ST
Mailing Address - Street 2:SUITE 511
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3116
Mailing Address - Country:US
Mailing Address - Phone:808-593-7703
Mailing Address - Fax:808-593-7703
Practice Address - Street 1:615 PIIKOI ST
Practice Address - Street 2:SUITE 511
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3116
Practice Address - Country:US
Practice Address - Phone:808-593-7703
Practice Address - Fax:808-593-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2011-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN13261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1336100049OtherNPI
HI25092001Medicaid