Organization
KAHALA CLINIC INTENSIVE TREATMENT PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON RICHARD KEIFER MD (PRESIDENT)
(808) 888-5228
Entity
Organization
Contact information
Practice address
4211 WAIALAE AVE STE 208, HONOLULU, HI 96816-5312
(808) 888-5228
(808) 732-6433
Mailing address
4211 WAIALAE AVE STE 208, HONOLULU, HI 96816-5312
(808) 888-5228
(808) 732-6433
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
GE-090-260-8896-01
HI
Other
Enumeration date
08/12/2017
Last updated
07/21/2022
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