Healthcare Provider Details

I. General information

NPI: 1942913876
Provider Name (Legal Business Name): KAMAUNU BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 WYNN RD STE D
LAS VEGAS NV
89102-8238
US

IV. Provider business mailing address

91-1173 KAUIKI ST
EWA BEACH HI
96706-2843
US

V. Phone/Fax

Practice location:
  • Phone: 808-364-7926
  • Fax:
Mailing address:
  • Phone: 808-364-7926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KOLLIN JAMES KAMAUNU
Title or Position: OWNER
Credential:
Phone: 808-364-7926