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General NPI Number Information
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NPI Number | 1922896174
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Entity Type | Organization
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Legal Business Name | KEONA REENTRY CENTER
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 412 CALIFORNIA AVE
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City | WAHIAWA
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State | HI
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Zip | 96786-1951
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Country | US
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Telephone | 808-840-7939
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Fax |
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Provider Business Mailing Address
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Address Line | 91-1629 KAUKOLU ST
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City | EWA BEACH
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State | HI
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Zip | 96706-4967
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Country | US
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Telephone | 808-238-9427
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELE UEMOTO-JOSEPH
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Credential |
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Telephone | 808-840-7939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #3
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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 #4
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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