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General NPI Number Information
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NPI Number | 1801044094
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Entity Type | Organization
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Legal Business Name | HILO MEDICAL CENTER HOME HEALTH EPSDT
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 09/03/2008
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Provider Practice Location Address
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Address Line | 1190 WAIANUENUE AVE
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City | HILO
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State | HI
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Zip | 96720-2020
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Country | US
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Telephone | 808-974-7720
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Fax | 808-974-4718
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Provider Business Mailing Address
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Address Line | 1190 WAIANUENUE AVE
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City | HILO
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State | HI
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Zip | 96720-2020
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Country | US
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Telephone | 808-974-7720
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Fax | 808-974-4718
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Authorized Official
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Title or Position | CEO
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Name | RONALD SCHURRA
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Credential |
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Telephone | 808-974-4729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | OHCA# HHA-2
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License Number State | HI
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