Organization
KOKUA VILLA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ROSALINE G. WHITLOCK (PRESIDENT/OWNER)
(808) 696-7000
Entity
Organization
Contact information
Practice address
86-080 FARRINGTON HWY, SUITE 102, WAIANAE, HI 96792-3069
(808) 696-7000
(808) 696-7003
Mailing address
86-080 FARRINGTON HWY, SUITE 102, WAIANAE, HI 96792-3069
(808) 696-7000
(808) 696-7003
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
HI
251S00000X
Community/Behavioral Health Agency
—
HI
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
516908
—
HI
Enumeration date
06/17/2009
Last updated
06/17/2009
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