# KAHALA CLINIC INTENSIVE TREATMENT PROGRAM

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306361241
- **Authorized official:** DR. JASON RICHARD KEIFER MD (PRESIDENT)
- **Authorized official phone:** (808) 888-5228

## Contact information

- **Practice address:** 4211 WAIALAE AVE STE 208, HONOLULU, HI 96816-5312
- **Practice address phone:** (808) 888-5228
- **Practice address fax:** (808) 732-6433
- **Mailing address:** 4211 WAIALAE AVE STE 208, HONOLULU, HI 96816-5312
- **Mailing address phone:** (808) 888-5228
- **Mailing address fax:** (808) 732-6433

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | GE-090-260-8896-01 | HI | Yes |

## Other

- **Enumeration date:** 08/12/2017
- **Last updated:** 07/21/2022