Organization
GERALD J MCKENNA M.D. INC DBA MCKENNA RECOVERY CENTER
Active
Organization
GERALD J MCKENNA M.D. INC DBA MCKENNA RECOVERY CENTER
Active
Other names
Ke Ala Pono Recovery Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERALD JAMES MCKENNA M.D. (CEO/MEDICAL DIRECTOR)
(808) 246-0663
Entity
Organization
Contact information
Practice address
4374 KUKUI GROVE ST, STE 104, LIHUE, HI 96766-2007
(808) 246-0663
(808) 246-1806
Mailing address
4374 KUKUI GROVE ST, STE 104, LIHUE, HI 96766-2007
(808) 246-0663
(808) 246-1806
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
MD6041
HI
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
MD6041
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02661901
—
HI
Enumeration date
04/09/2013
Last updated
09/02/2015
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