Healthcare Provider Details

I. General information

NPI: 1831384114
Provider Name (Legal Business Name): ST. JUDE HOSPICE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-910 MOLOALO ST
WAIPAHU HI
96797-6302
US

IV. Provider business mailing address

94-910 MOLOALO ST
WAIPAHU HI
96797-6302
US

V. Phone/Fax

Practice location:
  • Phone: 808-306-3676
  • Fax: 808-678-3604
Mailing address:
  • Phone: 808-306-3676
  • Fax: 808-678-3604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberW44509341-01
License Number StateHI

VIII. Authorized Official

Name: MR. ELEUTERIO CALDERON ARNOBIT JR.
Title or Position: BUSINESS MANAGER
Credential:
Phone: 808-306-3676