Provider Demographics
NPI:1588171284
Name:MALAMA OLA HEALTH SERVICES LLC
Entity type:Organization
Organization Name:MALAMA OLA HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:DUICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-543-1188
Mailing Address - Street 1:PO BOX 30273
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96820-0273
Mailing Address - Country:US
Mailing Address - Phone:808-543-1188
Mailing Address - Fax:808-543-1189
Practice Address - Street 1:1783 PIIKEA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-1849
Practice Address - Country:US
Practice Address - Phone:808-543-1188
Practice Address - Fax:808-543-1189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-03
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI17-02251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI828577Medicaid