Healthcare Provider Details

I. General information

NPI: 1033354113
Provider Name (Legal Business Name): PARADISE HOME CARE COOPERATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11-2860 ALII KANE ST
VOLCANO HI
96785
US

IV. Provider business mailing address

PO BOX 2121
VOLCANO HI
96785-2121
US

V. Phone/Fax

Practice location:
  • Phone: 808-985-9874
  • Fax: 808-985-9874
Mailing address:
  • Phone: 808-985-9874
  • Fax: 808-985-9874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MS. OCHANA D BRINGMAN-CONWAY
Title or Position: EXECUTIVE MANAGER
Credential: B.S.
Phone: 808-985-9874