Healthcare Provider Details

I. General information

NPI: 1346476942
Provider Name (Legal Business Name): BENCHMARK BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 WAIMANO HOME RD
PEARL CITY HI
96782-1478
US

IV. Provider business mailing address

2501 WAIMANO HOME RD P. O. BOX 1196
PEARL CITY HI
96782-1478
US

V. Phone/Fax

Practice location:
  • Phone: 808-454-1411
  • Fax:
Mailing address:
  • Phone: 808-454-1411
  • Fax: 808-454-0659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN BLOTZKE
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 808-454-1411