MEDICARE: MENTAL HEALTH KOKUA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3104A0625X	Assisted Living Facility (Mental Illness)

General Provider Information

NPI Number	:	1144645144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENTAL HEALTH KOKUA

Provider Business Mailing Address
First Line	:	1221 KAPIOLANI BLVD
Second Line	:	STE 345
City	:	HONOLULU
State	:	HI
Zip	:	96814-3503
Country	:	US
Telephone Number	:	808-737-2523
Fax Number	:

Provider Business Practice Location Address
First Line	:	1296 HOOLI CIR
Second Line	:	DUPLEX 11
City	:	PEARL CITY
State	:	HI
Zip	:	96782-1907
Country	:	US
Telephone Number	:	808-737-2523
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	GREG PAYTON
Credential	:
Telephone Number	:	808-737-2523

Provider Enumeration Date	:	02/27/2014
Last Update Date	:	02/27/2014

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Directions to “MENTAL HEALTH KOKUA ” Practice Location

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