Provider Demographics
NPI:1477851806
Name:E OLA PONO BEHAVIORAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:E OLA PONO BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JODDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANUWAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-222-0093
Mailing Address - Street 1:122 ONEAWA ST STE 203
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2524
Mailing Address - Country:US
Mailing Address - Phone:808-286-1949
Mailing Address - Fax:
Practice Address - Street 1:122 ONEAWA ST STE 203
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2524
Practice Address - Country:US
Practice Address - Phone:808-286-1949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI159251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health