Provider Demographics
NPI:1861634529
Name:MANAWA LEA HEALTH SERVICES INC
Entity Type:Organization
Organization Name:MANAWA LEA HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:MAGDALENA
Authorized Official - Last Name:RABAGO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:808-484-5635
Mailing Address - Street 1:PO BOX 1089
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-1089
Mailing Address - Country:US
Mailing Address - Phone:808-484-5635
Mailing Address - Fax:808-484-5636
Practice Address - Street 1:94-673 KUPUOHI STREET C108
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-5372
Practice Address - Country:US
Practice Address - Phone:808-686-9800
Practice Address - Fax:808-484-5636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1902993199Medicaid