Healthcare Provider Details

I. General information

NPI: 1871660902
Provider Name (Legal Business Name): SALVATION ARMY ADDICTION TREATMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3624 WAOKANAKA ST
HONOLULU HI
96817-5224
US

IV. Provider business mailing address

3624 WAOKANAKA ST
HONOLULU HI
96817-5224
US

V. Phone/Fax

Practice location:
  • Phone: 808-595-6371
  • Fax: 808-595-8250
Mailing address:
  • Phone: 808-595-6371
  • Fax: 808-595-8250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberOHCA#13-STF
License Number StateHI

VIII. Authorized Official

Name: MR. LAWRENCE H. WILLIAMS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 808-595-6371