Healthcare Provider Details

I. General information

NPI: 1073674602
Provider Name (Legal Business Name): LOKAHI TREATMENT CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68-1845 WAIKOLOA ROAD WAIKOLOA HIGHLANDS SHOPPING CENTER SUITE 224B
WAIKOLOA HI
96738
US

IV. Provider business mailing address

PO BOX 383401
WAIKOLOA HI
96738-3401
US

V. Phone/Fax

Practice location:
  • Phone: 808-883-0922
  • Fax: 808-883-1022
Mailing address:
  • Phone: 808-883-0922
  • Fax: 808-883-1022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateHI

VIII. Authorized Official

Name: DR. JAMAL F. WASAN
Title or Position: CEO
Credential: PHD, CSAC
Phone: 808-883-0922