Provider Demographics
NPI:1568180602
Name:MANA PONO HOLOMUA
Entity Type:Organization
Organization Name:MANA PONO HOLOMUA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THELMA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-773-5548
Mailing Address - Street 1:1121 ALA NAPUNANI ST APT 1004
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-1604
Mailing Address - Country:US
Mailing Address - Phone:808-773-5548
Mailing Address - Fax:
Practice Address - Street 1:1121 ALA NAPUNANI ST APT 1004
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-1604
Practice Address - Country:US
Practice Address - Phone:808-773-5548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MANA PONO HOLOMUA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty