Provider Demographics
NPI:1316694417
Name:OHANA DEVELOPMENTAL HOMES LLC
Entity type:Organization
Organization Name:OHANA DEVELOPMENTAL HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-680-6843
Mailing Address - Street 1:2710 W SOUTHERN AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-4501
Mailing Address - Country:US
Mailing Address - Phone:602-341-6990
Mailing Address - Fax:
Practice Address - Street 1:2710 W SOUTHERN AVE STE 106
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-4501
Practice Address - Country:US
Practice Address - Phone:602-341-6990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities