Provider Demographics
NPI:1962974998
Name:MAU LOA LEARNING
Entity type:Organization
Organization Name:MAU LOA LEARNING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ATWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-892-4059
Mailing Address - Street 1:1604 PERRY ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-3628
Mailing Address - Country:US
Mailing Address - Phone:808-368-9378
Mailing Address - Fax:
Practice Address - Street 1:41-611 INOAOLE ST
Practice Address - Street 2:
Practice Address - City:WAIMANALO
Practice Address - State:HI
Practice Address - Zip Code:96795-1211
Practice Address - Country:US
Practice Address - Phone:808-892-4059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty