1417683111 NPI number — KITOKO GOLDEN LIFE LLC

Table of content: (NPI 1417683111)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417683111 NPI number — KITOKO GOLDEN LIFE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KITOKO GOLDEN LIFE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GINAK COUNSELING SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417683111
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3043 ARIZONA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96818-3643
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-598-9522
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7431 N 140TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68142-2168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-598-9522
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/26/2022

Additional Information

Authorized Official

Authorized Official Last Name:
CHRISTOPHER
Authorized Official First Name:
GINA
Authorized Official Middle Name:
MUJINGA
Authorized Official Title or Position:
CLINICIAN
Authorized Official Telephone Number:
402-598-9522

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5617 . This is a "1659930642" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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