Healthcare Provider Details

I. General information

NPI: 1407887813
Provider Name (Legal Business Name): KAUAI HOSPICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4457 PAHEE ST
LIHUE HI
96766-2032
US

IV. Provider business mailing address

4457 PAHEE ST
LIHUE HI
96766-2032
US

V. Phone/Fax

Practice location:
  • Phone: 808-245-7277
  • Fax: 808-245-5006
Mailing address:
  • Phone: 808-245-7277
  • Fax: 808-245-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberW4041779201
License Number StateHI

VIII. Authorized Official

Name: MRS. JUDITH C SMITH
Title or Position: EXECUTIVE DIRECTOR
Credential: RN
Phone: 808-245-7277