Provider Demographics
NPI:1558082917
Name:OLA LOA LIFECARE CONCIERGE INC
Entity Type:Organization
Organization Name:OLA LOA LIFECARE CONCIERGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DENT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:808-281-0255
Mailing Address - Street 1:910 HONOAPIILANI HWY STE 7-206
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-1507
Mailing Address - Country:US
Mailing Address - Phone:808-281-0255
Mailing Address - Fax:808-443-0315
Practice Address - Street 1:968 KANAKEA LOOP
Practice Address - Street 2:
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-1320
Practice Address - Country:US
Practice Address - Phone:808-281-0255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty