Provider Demographics
NPI:1871051235
Name:OHANA, LLC
Entity type:Organization
Organization Name:OHANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GREGORY GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:BS ED
Authorized Official - Phone:606-425-2274
Mailing Address - Street 1:170 N SHADY LN
Mailing Address - Street 2:
Mailing Address - City:EUBANK
Mailing Address - State:KY
Mailing Address - Zip Code:42567-7659
Mailing Address - Country:US
Mailing Address - Phone:606-425-2274
Mailing Address - Fax:606-802-2266
Practice Address - Street 1:170 N SHADY LN
Practice Address - Street 2:
Practice Address - City:EUBANK
Practice Address - State:KY
Practice Address - Zip Code:42567-7659
Practice Address - Country:US
Practice Address - Phone:606-425-2274
Practice Address - Fax:606-802-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness