# HALE KIPA, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164627246
- **Authorized official:** MRS. VENUS VENUS ROSETE-MEDEIROS (CEO)
- **Authorized official phone:** (808) 589-1829

## Contact information

- **Practice address:** 91-2128 OLD FT WEAVER RD, EWA BEACH, HI 96706-1911
- **Practice address phone:** (808) 589-1829
- **Practice address fax:** (808) 589-2610
- **Mailing address:** 91-2128 OLD FT WEAVER RD, EWA BEACH, HI 96706-1911
- **Mailing address phone:** (808) 589-1829
- **Mailing address fax:** (808) 589-2610

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | W2005550002 | HI | Yes |

## Other

- **Enumeration date:** 06/18/2007
- **Last updated:** 05/11/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | W2005550002 | HAWAII TAX ID | HI |