Healthcare Provider Details

I. General information

NPI: 1598902744
Provider Name (Legal Business Name): NARCONON HAWAII
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90-1011 LEXINGTON AVENUE
KAPOLEI HI
76707
US

IV. Provider business mailing address

PO BOX 75246
KAPOLEI HI
96707-0246
US

V. Phone/Fax

Practice location:
  • Phone: 808-550-0005
  • Fax: 808-550-0009
Mailing address:
  • Phone: 808-550-0005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHANNON L FARNSWORTH
Title or Position: DIRECTOR OF LEGAL AFFAIRS
Credential:
Phone: 323-871-8644