Provider Demographics
NPI:1194544015
Name:OHANA, LLC
Entity type:Organization
Organization Name:OHANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ZENOBIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-570-0421
Mailing Address - Street 1:1635 EDMONDSON AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-1264
Mailing Address - Country:US
Mailing Address - Phone:443-835-4821
Mailing Address - Fax:443-869-2277
Practice Address - Street 1:23 E NORTH AVE UPPR LEVEL
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-5905
Practice Address - Country:US
Practice Address - Phone:443-835-4821
Practice Address - Fax:443-869-2277
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OHANA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit