Provider Demographics
NPI:1922833433
Name:SOUTHERN CROSS WELLNESS MAUI LLC
Entity type:Organization
Organization Name:SOUTHERN CROSS WELLNESS MAUI LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MOTR/L, CHT, CLT,
Authorized Official - Phone:808-561-5171
Mailing Address - Street 1:PO BOX 790824
Mailing Address - Street 2:
Mailing Address - City:PAIA
Mailing Address - State:HI
Mailing Address - Zip Code:96779-0824
Mailing Address - Country:US
Mailing Address - Phone:808-561-5171
Mailing Address - Fax:
Practice Address - Street 1:120 BALDWIN AVE UNIT 790824
Practice Address - Street 2:
Practice Address - City:PAIA
Practice Address - State:HI
Practice Address - Zip Code:96779-3033
Practice Address - Country:US
Practice Address - Phone:808-561-5171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-04
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty