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Organization
HALE KOKUA, INC.
Active
Organization
HALE KOKUA, INC.
Active
Other names
South Grant ICF / DDH
Organization subpart
No
Provider details
NPI number
Authorized official
MISS PUREZA A. GANIO (CEO)
(650) 520-5545
Entity
Organization
Contact information
Practice address
1618 S GRANT ST, SAN MATEO, CA 94402-2657
(650) 578-1183
Mailing address
1433 DAKOTA AVENUE, SAN MATEO, CA 94401
(650) 685-4779
(650) 627-4357
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
220000232
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LTC60789H
PROVIDER NUMBER
CA
Enumeration date
07/02/2007
Last updated
01/21/2015
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