Healthcare Provider Details

I. General information

NPI: 1215573381
Provider Name (Legal Business Name): HILO SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

563 KAUMANA DR
HILO HI
96720-1812
US

IV. Provider business mailing address

45-181 WAIKALUA RD
KANEOHE HI
96744-2765
US

V. Phone/Fax

Practice location:
  • Phone: 808-498-0100
  • Fax:
Mailing address:
  • Phone: 808-247-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: RANDALL HATA
Title or Position: VP
Credential:
Phone: 808-791-4496