GERALD J MCKENNA M.D. INC DBA MCKENNA RECOVERY CENTER (NPI# 1013350099) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013350099 |
| Entity Type | Organization |
| Organization Name | GERALD J MCKENNA M.D. INC DBA MCKENNA RECOVERY CENTER |
| Other Organization Name | KE ALA PONO RECOVERY CENTER |
| Practice Address |
4374 Kukui Grove St Ste 104 Lihue HI 96766-2007 |
| Practice Telephone | 8082460663 |
| Practice Fax Number | 8082461806 |
| Mailing Telephone | 8082460663 |
| Mailing Fax Number | 8082461806 |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2015-09-02 |
| Authorized Official Name | DR. GERALD JAMES MCKENNA (CEO/MEDICAL DIRECTOR) |
| Authorized Official Telephone | 8082460663 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
MD6041 | HI | Allopathic & Osteopathic Physicians |
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
MD6041 | HI | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| HI | 02661901 | 05 |
| Other Name | Type Code |
|---|---|
| Ke Ala Pono Recovery Center | Former Legal Business Name - Organization |
| Street Address |
4374 KUKUI GROVE ST STE 104 |
| City | LIHUE |
| State | HI |
| Zip Code | 96766-2007 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790875458 | John Winnes | Social Worker | 4374 Kukui Grove St, Suite 102, Lihue, HI 96766-2007 | 2006-10-13 |
| 1457785602 | Jon W. Nakamura, M.d., Inc. | Clinic/Center | 4374 Kukui Grove St, Suite # 102, Lihue, HI 96766-2007 | 2013-08-23 |
| 1215059704 | Jon Nakamura Nakamura | Psychiatry & Neurology | 4374 Kukui Grove St, Suite # 102, Lihue, HI 96766-2007 | 2007-04-04 |
| 1902952385 | Gerald James Mckenna | Psychiatry & Neurology | 4374 Kukui Grove St, Suite 104, Lihue, HI 96766-2007 | 2007-01-26 |
| 1932253796 | Michael Edward Foley | Social Worker | 4374 Kukui Grove St, Suite #102, Lihue, HI 96766-2007 | 2007-01-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154989747 | Amber Denise Leach | Hearing Instrument Specialist | 4405 Kukei Grove St Suite 101, Lihue, HI 96766 | 2019-05-30 |
| 1730746264 | Maria Celeste I Papa | Home Health | 2980 Ewalu St., Unit 1, Lihue, HI 96766 | 2019-05-20 |
| 1588141287 | Dr. Joseph Schafermeyer LLC. | Dentist | 4381 Kukui Grove St., Ste. 2, Lihue, HI 96766 | 2018-07-25 |
| 1497232466 | Island Hand Therapy Clinic LLC | Occupational Therapist | 3175 Elua St Ste A, Lihue, HI 96766 | 2018-07-23 |
| 1245717578 | Robert M. Long, Dds. Inc. | Dentist | 4359 Kukui Grove Street, Suite 104, Lihue, HI 96766 | 2018-07-19 |
| 1922599547 | Annette Marisa Martinez | Behavior Technician | 3-3367 Kuhio Hwy # 211, Lihue, HI 96766 | 2018-05-21 |
| 1053822510 | Christopher Michael Wilson | Behavior Technician | 3-3367 Kuhio Hwy Ste 204, Lihue, HI 96766 | 2017-10-23 |
| 1740706308 | Kaumualii Medical Supplies | Durable Medical Equipment & Medical Supplies | 3-2600 Kaumualii Hwy 1300 #114, Lihue, HI 96766 | 2017-08-16 |
| 1629598925 | Araceli Rapozo | Counselor | 4370-kukui Grove St Suite 3-211, Lihue, HI 96766 | 2017-06-27 |
| 1629504725 | Chantelle Kane | Behavioral Analyst | 3122 Kuhio Hwy, Lihue, HI 96766 | 2017-05-10 |
| Find all providers in zip 96766 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265068233 | Diane Logan LLC | Clinic/Center | 75-127 Lunapule Rd Ste 15b, Kailua Kona, HI 96740-2119 | 2020-03-20 |
| 1679866339 | Dawn Patrol Assessments | Clinic/Center | 901 River St, #804, Honolulu, HI 96817-5320 | 2011-05-26 |
| 1750412623 | Waianae District Comprehensive Health and Hospital Board, Incorporated | Clinic/Center | 86-260 Farrington Hwy, Waianae, HI 96792-3128 | 2007-03-09 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.