| Organization Name: | GERALD J MCKENNA M.D. INC DBA MCKENNA RECOVERY CENTER |
| NPI Number: | 1013350099 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GERALD JAMES MCKENNA (CEO/MEDICAL DIRECTOR) |
| Mailing Address: | 4374 Kukui Grove St Ste 104 Lihue |
| State: | HI US |
| Postal Code: | 967662007 |
| Phone Number: | 8082460663 |
| Fax Number: | 8082461806 |
| NPI Enumeration Date: | 04/09/2013 |
| NPI Last Update Date: | 09/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2084A0401X |
| License Number: | MD6041 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | HI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Psychiatry & Neurology |
| Taxonomy Specialization: | Addiction Medicine |
| Taxonomy Definition: | A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |