Provider Demographics
NPI:1578689816
Name:KLINE-WELSH BEHAVIORAL HEALTH FONDATION
Entity Type:Organization
Organization Name:KLINE-WELSH BEHAVIORAL HEALTH FONDATION
Other - Org Name:THE SAND ISLAND TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CSAPA
Authorized Official - Phone:808-842-7529
Mailing Address - Street 1:PO BOX 3045
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96802-3045
Mailing Address - Country:US
Mailing Address - Phone:808-841-3915
Mailing Address - Fax:808-841-4278
Practice Address - Street 1:1240 SAND ISLAND PKWY
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4315
Practice Address - Country:US
Practice Address - Phone:808-841-3915
Practice Address - Fax:808-841-4278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOHCA #1-STF324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility