Healthcare Provider Details

I. General information

NPI: 1922896174
Provider Name (Legal Business Name): KEONA REENTRY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 CALIFORNIA AVE
WAHIAWA HI
96786-1951
US

IV. Provider business mailing address

91-1629 KAUKOLU ST
EWA BEACH HI
96706-4967
US

V. Phone/Fax

Practice location:
  • Phone: 808-840-7939
  • Fax:
Mailing address:
  • Phone: 808-238-9427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MICHELE UEMOTO-JOSEPH
Title or Position: OWNER
Credential:
Phone: 808-840-7939