Provider Demographics
NPI:1033366216
Name:THE BOBBY BENSON CENTER
Entity Type:Organization
Organization Name:THE BOBBY BENSON CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN MARIE
Authorized Official - Last Name:MINES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:808-293-7555
Mailing Address - Street 1:56-660 KAMEHAMEHA HWY
Mailing Address - Street 2:
Mailing Address - City:KAHUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96731-2210
Mailing Address - Country:US
Mailing Address - Phone:808-293-7555
Mailing Address - Fax:808-293-7196
Practice Address - Street 1:56-660 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:KAHUKU
Practice Address - State:HI
Practice Address - Zip Code:96731-2210
Practice Address - Country:US
Practice Address - Phone:808-293-7555
Practice Address - Fax:808-293-7196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children