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General NPI Number Information
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NPI Number | 1164841680
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Entity Type | Organization
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Legal Business Name | MENTAL HEALTH KOKUA
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Dates
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Enumeration Date | 04/11/2014
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Last Update Date | 04/11/2014
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Provider Practice Location Address
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Address Line | 75-5748 ALANOE STREET, HALE ALAN
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City | KAILUA KONA
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State | HI
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Zip | 96740
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Country | US
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Telephone | 808-463-8907
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 KAPIOLANI BLVD STE 345
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City | HONOLULU
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State | HI
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Zip | 96814-3503
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Country | US
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Telephone | 808-463-8907
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Fax |
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Authorized Official
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Title or Position | ED
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Name | MR. GREG PAYTON
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Credential |
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Telephone | 808-463-8907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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