Provider Demographics
NPI:1083454821
Name:MAILE PAVAO LLC
Entity type:Organization
Organization Name:MAILE PAVAO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MAILE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVAO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:808-769-0401
Mailing Address - Street 1:58 KINOOLE STREET
Mailing Address - Street 2:SUITE 108
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2490
Mailing Address - Country:US
Mailing Address - Phone:808-769-0401
Mailing Address - Fax:808-315-7002
Practice Address - Street 1:58 KINOOLE STREET
Practice Address - Street 2:SUITE 108
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2490
Practice Address - Country:US
Practice Address - Phone:808-769-0401
Practice Address - Fax:808-315-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health