Provider Demographics
NPI:1881305357
Name:MENTALOHA LLC
Entity type:Organization
Organization Name:MENTALOHA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:808-725-2008
Mailing Address - Street 1:4144 AIKEPA ST
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-8131
Mailing Address - Country:US
Mailing Address - Phone:808-855-5775
Mailing Address - Fax:808-461-7098
Practice Address - Street 1:4210 HANAHAO PL STE 202
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-9036
Practice Address - Country:US
Practice Address - Phone:808-725-2008
Practice Address - Fax:808-461-7098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI004616Medicaid