Provider Demographics
NPI:1952618357
Name:HAWAII ISLAND RECOVERY, LLC
Entity Type:Organization
Organization Name:HAWAII ISLAND RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HIBSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-323-2607
Mailing Address - Street 1:73-4697 HINA LANI ST
Mailing Address - Street 2:P.O. BOX 785
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-9223
Mailing Address - Country:US
Mailing Address - Phone:866-515-5032
Mailing Address - Fax:866-515-5042
Practice Address - Street 1:75-170 HUALALAI RD
Practice Address - Street 2:SUITE C311A
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1779
Practice Address - Country:US
Practice Address - Phone:866-515-5032
Practice Address - Fax:866-515-5042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI102-STF323P00000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment FacilityGroup - Multi-Specialty