Provider Demographics
NPI:1669673133
Name:MALAMA HALE INC.
Entity Type:Organization
Organization Name:MALAMA HALE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QMRP
Authorized Official - Prefix:MISS
Authorized Official - First Name:PACIFICO
Authorized Official - Middle Name:T
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:650-703-5703
Mailing Address - Street 1:5105 SLOAN WAY
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-5560
Mailing Address - Country:US
Mailing Address - Phone:650-703-5760
Mailing Address - Fax:510-324-3566
Practice Address - Street 1:5105 SLOAN WAY
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-5560
Practice Address - Country:US
Practice Address - Phone:510-324-4366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities