Healthcare Provider Details

I. General information

NPI: 1366316754
Provider Name (Legal Business Name): IRECOVERED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 KAMEHAMEHA HWY STE 309
PEARL CITY HI
96782-2638
US

IV. Provider business mailing address

803 KAMEHAMEHA HWY STE 309
PEARL CITY HI
96782-2638
US

V. Phone/Fax

Practice location:
  • Phone: 401-684-8051
  • Fax:
Mailing address:
  • Phone: 401-684-8051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: EDWIN JOHNSON
Title or Position: DIRECTOR
Credential:
Phone: 401-684-8051