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General NPI Number Information
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NPI Number | 1588394472
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Entity Type | Organization
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Legal Business Name | MANA RECOVERY LLC
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Dates
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Enumeration Date | 06/14/2022
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Last Update Date | 06/13/2023
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Provider Practice Location Address
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Address Line | 1063 LOWER MAIN ST STE C211A213
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City | WAILUKU
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State | HI
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Zip | 96793-2038
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Country | US
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Telephone | 808-867-9268
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 736
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City | HAIKU
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State | HI
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Zip | 96708-0736
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MR. OWEN JAMES CAMPBELL
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Credential |
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Telephone | 516-474-1951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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