Provider Demographics
NPI:1104599901
Name:OHANA NAMPA OPERATIONS, LLC
Entity type:Organization
Organization Name:OHANA NAMPA OPERATIONS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HILTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-250-3825
Mailing Address - Street 1:PO BOX 988
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-0109
Mailing Address - Country:US
Mailing Address - Phone:503-250-3825
Mailing Address - Fax:
Practice Address - Street 1:1355 S EDGEWATER CIR
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6085
Practice Address - Country:US
Practice Address - Phone:503-250-3825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility