Johanna Park
Community/Behavioral Health in Hilo, HI. Organization (NPI-2).
NPI number1093252124
StatusActive
Last updated in NPPESDec 17, 2025
Details
- NPI
- 1093252124
- Entity type
- Organization (NPI-2)
- Legal business name
- Johanna Park
- Organization subpart
- No
- Enumeration date
- Jan 27, 2017
- Certification date
- Dec 17, 2025
- Last updated
- Dec 17, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 251S00000X | Community/Behavioral Health | LMHC 427 | HI | Yes |
Practice location
120 Keawe St Ste 203bSuite 202
Hilo, HI 96720-2874
Phone 808-315-1432
Mailing address
16-566 Keaau Pahoa Rd Ste 188-367Keaau, HI 96749-8137
Phone 808-315-1432
Authorized official
Johanna Lynn Park
Owner
8083151432
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