HALE KOKUA INC. NPI 1073710976

NPI Information

NPI: 1073710976
Provider Name: HALE KOKUA, INC.

Other Name: SOUTH GRANT ICF / DDH

Classification: Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320600000X
Entity Type: Organization
Address:
1618 S GRANT ST
SAN MATEO, CA
ZIP 94402
Phone: (650) 578-1183
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HALE KOKUA, INC. is a residential treatment facility, intellectual and/or developmental disabilities in San Mateo, CA. The provider is a residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently. HALE KOKUA, INC. NPI is 1073710976. The provider is registered as an organization entity type.
The provider Other Name Is South Grant Icf / Ddh.

The provider's business location address is:

1618 S GRANT ST
SAN MATEO, CA
ZIP 94402-657
Phone: (650) 578-1183

The provider's authorized official is Pureza A. Ganio .
The authorized official title is Ceo and has the following contact phone number (650) 520-5545.

The enumeration date for this NPI number is 7/2/2007 and was last updated on 1/21/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	320600000X	Residential Treatment Facility, Intellectual and/or Developmental Disabilities		220000232	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	LTC60789H	OTHER	CALIFORNIA	PROVIDER NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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