Provider Demographics
NPI:1386236966
Name:THE OHANA RETREAT LLC
Entity type:Organization
Organization Name:THE OHANA RETREAT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-664-2622
Mailing Address - Street 1:75-5915 WALUA RD
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1375
Mailing Address - Country:US
Mailing Address - Phone:877-664-2622
Mailing Address - Fax:
Practice Address - Street 1:73-4617 KALOKO HALIA PL
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-8666
Practice Address - Country:US
Practice Address - Phone:808-746-9003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE OHANA RETREAT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-05
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit