Provider Demographics
NPI:1922896174
Name:KEONA REENTRY CENTER
Entity type:Organization
Organization Name:KEONA REENTRY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:UEMOTO-JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-840-7939
Mailing Address - Street 1:91-1629 KAUKOLU ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-4967
Mailing Address - Country:US
Mailing Address - Phone:808-238-9427
Mailing Address - Fax:
Practice Address - Street 1:412 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-1951
Practice Address - Country:US
Practice Address - Phone:808-840-7939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health