Provider Demographics
NPI:1841440039
Name:MALAMA OHANA GROUP, LLC
Entity type:Organization
Organization Name:MALAMA OHANA GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RESIDENT AGENT
Authorized Official - Prefix:
Authorized Official - First Name:GLADIOLI
Authorized Official - Middle Name:ESPIRITU
Authorized Official - Last Name:DAUZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:702-480-4132
Mailing Address - Street 1:4024 PERFECT LURE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129
Mailing Address - Country:US
Mailing Address - Phone:702-480-4132
Mailing Address - Fax:
Practice Address - Street 1:4024 PERFECT LURE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-6089
Practice Address - Country:US
Practice Address - Phone:702-480-4132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4881-BPR-0251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4881-BPR-0OtherSTATE OF NEVADA DEPARTMENT OF HEALTH- BLC