Provider Demographics
NPI:1700038155
Name:MAKAHA CLUBHOUSE
Entity Type:Organization
Organization Name:MAKAHA CLUBHOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL RESOURCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKAHARA
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:808-586-8276
Mailing Address - Street 1:84-1170 FARRINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-2060
Mailing Address - Country:US
Mailing Address - Phone:808-721-0745
Mailing Address - Fax:
Practice Address - Street 1:84-1170 FARRINGTON HWY
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-2060
Practice Address - Country:US
Practice Address - Phone:808-721-0745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAKAHA MENTAL HEALTH CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health