Provider Demographics
NPI:1497466064
Name:OHANAS CONNECTION LLC
Entity Type:Organization
Organization Name:OHANAS CONNECTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANTESE
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-503-1879
Mailing Address - Street 1:334 SONOMA RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-8405
Mailing Address - Country:US
Mailing Address - Phone:252-503-1879
Mailing Address - Fax:
Practice Address - Street 1:413 S GLANCY ST
Practice Address - Street 2:
Practice Address - City:SWANSBORO
Practice Address - State:NC
Practice Address - Zip Code:28584-9656
Practice Address - Country:US
Practice Address - Phone:252-503-1879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2023-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC320900000XMedicaid
NC385H00000XMedicaid
NC320800000XMedicaid