Healthcare Provider Details

I. General information

NPI: 1578689816
Provider Name (Legal Business Name): KLINE-WELSH BEHAVIORAL HEALTH FONDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 SAND ISLAND PKWY
HONOLULU HI
96819-4315
US

IV. Provider business mailing address

PO BOX 3045
HONOLULU HI
96802-3045
US

V. Phone/Fax

Practice location:
  • Phone: 808-841-3915
  • Fax: 808-841-4278
Mailing address:
  • Phone: 808-841-3915
  • Fax: 808-841-4278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberOHCA #1-STF
License Number StateHI

VIII. Authorized Official

Name: MR. MASON HENDERSON
Title or Position: EXECUTIVE DIRECTOR
Credential: CSAPA
Phone: 808-842-7529