Provider Demographics
NPI:1972673093
Name:OHANA PACIFIC REHABILITATION SERVICES, LLC
Entity Type:Organization
Organization Name:OHANA PACIFIC REHABILITATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:LOCKETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-262-1118
Mailing Address - Street 1:354 ULUNIU ST.
Mailing Address - Street 2:SUITE 404
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734
Mailing Address - Country:US
Mailing Address - Phone:808-262-1118
Mailing Address - Fax:808-262-0045
Practice Address - Street 1:354 ULUNIU ST
Practice Address - Street 2:SUITE 404
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:808-262-1118
Practice Address - Fax:808-262-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI225100000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI204196700OtherOWCP
HI00B0227351OtherHMSA
HIH52970Medicare ID - Type Unspecified