Provider Demographics
NPI:1336844422
Name:MAOLI OLA INTEGRATED CARE, LLC
Entity Type:Organization
Organization Name:MAOLI OLA INTEGRATED CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DYANNA
Authorized Official - Middle Name:LEOLANI
Authorized Official - Last Name:AH QUIN
Authorized Official - Suffix:
Authorized Official - Credentials:DBH
Authorized Official - Phone:480-356-3271
Mailing Address - Street 1:11148 E VICTORIA ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-7811
Mailing Address - Country:US
Mailing Address - Phone:480-356-3271
Mailing Address - Fax:
Practice Address - Street 1:11148 E VICTORIA ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-7811
Practice Address - Country:US
Practice Address - Phone:480-356-3271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-30
Last Update Date:2023-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty