| Gerald J Mckenna M.d. Inc Dba Mckenna Recovery Center | |
|
4374 Kukui Grove St Ste 104 Lihue HI 96766-2007 | |
| (808) 246-0663 | |
| (808) 246-1806 |
| Full Name | Gerald J Mckenna M.d. Inc Dba Mckenna Recovery Center |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 4374 Kukui Grove St, Lihue, Hawaii |
| Authorized Official Name and Position | Gerald James Mckenna (CEO/MEDICAL DIRECTOR) |
| Authorized Official Contact | 8082460663 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gerald J Mckenna M.d. Inc Dba Mckenna Recovery Center 4374 Kukui Grove St Ste 104 Lihue HI 96766-2007 Ph: (808) 246-0663 | Gerald J Mckenna M.d. Inc Dba Mckenna Recovery Center 4374 Kukui Grove St Ste 104 Lihue HI 96766-2007 Ph: (808) 246-0663 |
| NPI Number | 1013350099 |
|---|---|
| Provider Enumeration Date | 04/09/2013 |
| Last Update Date | 09/02/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013350099 | NPI | - | NPPES |
| 02661901 | Medicaid | HI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084A0401X | Psychiatry & Neurology - Addiction Medicine | MD6041 (Hawaii) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | MD6041 (Hawaii) | Primary |
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