Provider Demographics
NPI:1700466877
Name:AWAKENING HEALING CENTER, LLC
Entity type:Organization
Organization Name:AWAKENING HEALING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CORAL
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-280-0608
Mailing Address - Street 1:64 KEAWE ST STE 207
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2486
Mailing Address - Country:US
Mailing Address - Phone:808-961-6887
Mailing Address - Fax:808-443-0510
Practice Address - Street 1:64 KEAWE ST STE 207
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2486
Practice Address - Country:US
Practice Address - Phone:808-961-6887
Practice Address - Fax:808-443-0510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI000354399OtherHMSA