GERALD J MCKENNA M.D. INC DBA MCKENNA RECOVERY CENTER NPI 1013350099

NPI Information

NPI: 1013350099
Provider Name: GERALD J MCKENNA M.D. INC DBA MCKENNA RECOVERY CENTER

Former Legal Business Name: KE ALA PONO RECOVERY CENTER

Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

CLIA Number: 12D2036132

Address:
4374 KUKUI GROVE ST
STE 104
LIHUE, HI
ZIP 96766
Phone: (808) 246-0663
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GERALD J MCKENNA M.D. INC DBA MCKENNA RECOVERY CENTER is a rehabilitation and substance use disorder clinic center in Lihue, HI. GERALD J MCKENNA M.D. INC DBA MCKENNA RECOVERY CENTER NPI is 1013350099. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Former Legal Business Name Is Ke Ala Pono Recovery Center.

The provider's business location address is:

4374 KUKUI GROVE ST
STE 104
LIHUE, HI
ZIP 96766-007
Phone: (808) 246-0663
Fax: (808) 246-1806

The provider's authorized official is Gerald James Mckenna .
The authorized official title is Ceo/medical Director and has the following contact phone number (808) 246-0663.

The CLIA number assigned to this NPI record is 12D2036132 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/9/2013 and was last updated on 9/2/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2084A0401X	Psychiatry & Neurology	Addiction Medicine	MD6041	HAWAII	No
2	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	MD6041	HAWAII	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0000BDQDT	MEDICARE UPIN	HAWAII
2	02661901	MEDICAID	HAWAII

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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