Provider Demographics
NPI:1164841680
Name:MENTAL HEALTH KOKUA
Entity Type:Organization
Organization Name:MENTAL HEALTH KOKUA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ED
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-463-8907
Mailing Address - Street 1:1221 KAPIOLANI BLVD
Mailing Address - Street 2:STE 345
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3503
Mailing Address - Country:US
Mailing Address - Phone:808-463-8907
Mailing Address - Fax:
Practice Address - Street 1:75-5748 ALANOE STREET,
Practice Address - Street 2:HALE ALAN
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740
Practice Address - Country:US
Practice Address - Phone:808-463-8907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-11
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness