1891051850 NPI number — HOSPICE OF HILO

Table of content: (NPI 1891051850)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891051850 NPI number — HOSPICE OF HILO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPICE OF HILO
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:
KUPU CARE
Provider Other Organization Name Type Code:
3
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:
1891051850
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1011 WAIANUENUE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILO
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96720-2019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-969-1733
Provider Business Mailing Address Fax Number:
808-961-7397

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
590 KAPIOLANI ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILO
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-969-1733
Provider Business Practice Location Address Fax Number:
808-961-7397
Provider Enumeration Date:
04/04/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HO
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
808-969-1733

Provider Taxonomy Codes

  • Taxonomy code: 207QH0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0 006411-3 . This is a "HAWAII MEDICAL SERVICES ASSOC." identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 055703-01 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".