Provider Demographics
NPI:1316277072
Name:THE BOBBY BENSON CENTER
Entity type:Organization
Organization Name:THE BOBBY BENSON CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:ANGUS
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-293-7555
Mailing Address - Street 1:56-660 KAMEHAMEHA HWY
Mailing Address - Street 2:
Mailing Address - City:KAHUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96731-2210
Mailing Address - Country:US
Mailing Address - Phone:808-293-7555
Mailing Address - Fax:808-293-7196
Practice Address - Street 1:56-660 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:KAHUKU
Practice Address - State:HI
Practice Address - Zip Code:96731-2210
Practice Address - Country:US
Practice Address - Phone:808-293-7555
Practice Address - Fax:808-293-7196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HICA#53-STF3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children