Healthcare Provider Details

I. General information

NPI: 1487586921
Provider Name (Legal Business Name): CLINCIAL RECOVERY SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4214 BOUGAINVILLE AVE APT B
KAPOLEI HI
96707-3506
US

IV. Provider business mailing address

4214 BOUGAINVILLE AVE APT B
KAPOLEI HI
96707-3506
US

V. Phone/Fax

Practice location:
  • Phone: 808-348-6270
  • Fax:
Mailing address:
  • Phone: 808-348-6270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRANDY COSTALES
Title or Position: MANAGING MEMBER
Credential: MAC, MSP, CSAC
Phone: 808-348-6270