Provider Demographics
NPI:1508574229
Name:HOUSE OF HEALING HAWAII LLC
Entity Type:Organization
Organization Name:HOUSE OF HEALING HAWAII LLC
Other - Org Name:HOUSE OF HEALING HAWAII
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHENELLE
Authorized Official - Middle Name:MICOLE
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:808-476-8983
Mailing Address - Street 1:500 ALA MOANA BLVD STE 7400
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-4902
Mailing Address - Country:US
Mailing Address - Phone:808-476-8983
Mailing Address - Fax:
Practice Address - Street 1:500 ALA MOANA BLVD STE 7400
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-4902
Practice Address - Country:US
Practice Address - Phone:808-476-8983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-10
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health