Provider Demographics
NPI:1477226868
Name:ORCHID ISLE WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:ORCHID ISLE WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:970-413-3776
Mailing Address - Street 1:73-1281 AWAKEA ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-9571
Mailing Address - Country:US
Mailing Address - Phone:970-413-3776
Mailing Address - Fax:833-536-1752
Practice Address - Street 1:73-1281 AWAKEA ST
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-9571
Practice Address - Country:US
Practice Address - Phone:970-413-3776
Practice Address - Fax:833-536-1752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-30
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty