Healthcare Provider Details

I. General information

NPI: 1326048406
Provider Name (Legal Business Name): HOSPICE OF HILO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 WAIANUENUE AVE
HILO HI
96720-2019
US

IV. Provider business mailing address

1011 WAIANUENUE AVE
HILO HI
96720-2019
US

V. Phone/Fax

Practice location:
  • Phone: 808-969-1733
  • Fax: 808-969-4863
Mailing address:
  • Phone: 808-969-1733
  • Fax: 808-961-7397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRENDA HO
Title or Position: EXECUTIVE DIRECTOR
Credential: RN MS
Phone: 808-969-1733