Organization
OHANA GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LYDIA KIM (ADMINISTRATOR)
(770) 825-3380
Entity
Organization
Contact information
Practice address
4124 STEVE REYNOLDS BLVD, NORCROSS, GA 30093-3059
(678) 924-0037
(678) 924-0038
Mailing address
4124 STEVE REYNOLDS BLVD, NORCROSS, GA 30093-3059
(678) 924-0037
(678) 924-0038
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
067-R-0870
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003130484A
—
GA
Enumeration date
08/26/2013
Last updated
08/26/2013
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