Hale Kokua, Inc.

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

220000232 Issued in CA

Legal business name

HALE KOKUA, INC.

Practice address

1618 S Grant St
San Mateo, CA 94402-2657

Phone

(650) 578-1183

NPI assigned

Jul 2, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miss Pureza A. Ganio

Title

Ceo

Phone

(650) 520-5545

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• South Grant ICF / DDH Other name

Tax ID family

Bay Horizon Icf DDH4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Bay Horizon Icf-DDH

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • San Mateo, CA
  • NPI 1003208281
  NPD tax ID
• Hake Kokua, Inc.

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • San Mateo, CA
  • NPI 1619174513
  NPD tax ID
• Hale Kokua, Inc.

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • San Mateo, CA
  • NPI 1174720072
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421798400000",
    "number": "1073710976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1433 DAKOTA AVENUE",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "94401",
            "telephone_number": "650-685-4779",
            "fax_number": "650-627-4357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1618 S GRANT ST",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944022657",
            "telephone_number": "650-578-1183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HALE KOKUA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-02",
        "last_updated": "2015-01-21",
        "status": "A",
        "authorized_official_last_name": "GANIO",
        "authorized_official_first_name": "PUREZA",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "650-520-5545",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CA",
            "license": "220000232",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NUMBER",
            "identifier": "LTC60789H",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Grant ICF / DDH",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Evelyn Victoria Haddad, M.D.
• Bill Haddock
• Christina Lee Hadley, PPS CREDENTIAL
• Angela Hagerman
• Hake Kokua, Inc.
• Hale Kokua, Inc.
• Trisha Haleakala
• Darryl Hall
• Joan C Haller, MSW
• Hallmark Hospice of Northern California, LLC

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.