MEDICARE: HILO MEDICAL INVESTORS LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	52-N	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376600098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILO MEDICAL INVESTORS LTD.

Provider Business Mailing Address
First Line	:	1333 WAIANUENUE AVE
Second Line	:
City	:	HILO
State	:	HI
Zip	:	96720-1202
Country	:	US
Telephone Number	:	808-961-6644
Fax Number	:	808-961-6630

Provider Business Practice Location Address
First Line	:	3001 KEITH ST NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3713
Country	:	US
Telephone Number	:	423-473-5751
Fax Number	:	423-339-8342

Authorized Official
Title or Position	:	ASSISTANT SECRETARY FOR LCCA, MGR
Name	:	CINDY S CROSS
Credential	:
Telephone Number	:	423-473-5867

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	01/05/2015

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