Provider Demographics
NPI:1104914837
Name:HALE MAHAOLU
Entity type:Organization
Organization Name:HALE MAHAOLU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-872-4100
Mailing Address - Street 1:200 HINA AVE
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-1821
Mailing Address - Country:US
Mailing Address - Phone:808-872-4100
Mailing Address - Fax:
Practice Address - Street 1:200 HINA AVE
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-1821
Practice Address - Country:US
Practice Address - Phone:808-872-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-12-11
Deactivation Date:2007-06-21
Deactivation Code:
Reactivation Date:2008-07-03
Provider Licenses
StateLicense IDTaxonomies
332U00000X, 253Z00000X
HI20013305251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Yes332U00000XSuppliersHome Delivered Meals
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI505373Medicaid