1235329897 NPI number — PARADISE RECOVERY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235329897 NPI number — PARADISE RECOVERY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARADISE RECOVERY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235329897
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1050 BISHOP ST
Provider Second Line Business Mailing Address:
STE 162
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96813-4210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-206-8462
Provider Business Mailing Address Fax Number:
866-241-7463

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7017 KALANIANAOLE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96825-2007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-206-8462
Provider Business Practice Location Address Fax Number:
866-241-7463
Provider Enumeration Date:
07/30/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NEUHAUS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
PARTRICK
Authorized Official Title or Position:
MEDICAL DIRECTOR AND CO-FOUNDER
Authorized Official Telephone Number:
18083866332

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  STF 86 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)