Provider Demographics
NPI:1992197297
Name:OAHU HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:OAHU HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:LACKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-412-4909
Mailing Address - Street 1:12680 HIGH BLUFF DR STE 150
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2232
Mailing Address - Country:US
Mailing Address - Phone:918-576-3070
Mailing Address - Fax:918-516-0609
Practice Address - Street 1:820 MILILANI ST STE 725
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2993
Practice Address - Country:US
Practice Address - Phone:808-492-1403
Practice Address - Fax:808-356-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHHA-19251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health