NPIMap

Organization Active NPI

Gerald J McKenna M.D. Inc Dba McKenna Recovery Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Lihue, HI
National Provider Identifier
1013350099
Registry record updated Sep 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
MD6041 Issued in HI
Legal business name
GERALD J MCKENNA M.D. INC DBA MCKENNA RECOVERY CENTER
Practice address
4374 Kukui Grove St
Ste 104
Lihue, HI 96766-2007
Phone
(808) 246-0663
Fax
(808) 246-1806
NPI assigned
Apr 9, 2013
Last updated
Sep 2, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Gerald James McKenna, M.D.
Title
Ceo/Medical Director
Phone
(808) 246-0663

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Psychiatry & Neurology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084A0401X MD6041 HI
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X MD6041 HI Primary

Addresses

Primary practice location

4374 Kukui Grove St
Ste 104
Lihue, HI 96766-2007

Mailing address

4374 Kukui Grove St
Ste 104
Lihue, HI 96766-2007
Phone (808) 246-0663

Other identifiers 1

IdentifierTypeStateIssuer
02661901MedicaidHI

Other names 1

  • Ke Ala Pono Recovery Center Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1365465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441152000000",
    "number": "1013350099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4374 KUKUI GROVE ST",
            "address_2": "STE 104",
            "city": "LIHUE",
            "state": "HI",
            "postal_code": "967662007",
            "telephone_number": "808-246-0663",
            "fax_number": "808-246-1806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4374 KUKUI GROVE ST",
            "address_2": "STE 104",
            "city": "LIHUE",
            "state": "HI",
            "postal_code": "967662007",
            "telephone_number": "808-246-0663",
            "fax_number": "808-246-1806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GERALD J MCKENNA M.D. INC DBA MCKENNA RECOVERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-09",
        "last_updated": "2015-09-02",
        "status": "A",
        "authorized_official_last_name": "MCKENNA",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "CEO/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "808-246-0663",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084A0401X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "HI",
            "license": "MD6041",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "HI",
            "license": "MD6041",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02661901",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ke Ala Pono Recovery Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Lihue, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.