Provider Demographics
NPI:1033354113
Name:PARADISE HOME CARE COOPERATIVE
Entity Type:Organization
Organization Name:PARADISE HOME CARE COOPERATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:OCHANA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRINGMAN-CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:808-985-9874
Mailing Address - Street 1:PO BOX 2121
Mailing Address - Street 2:
Mailing Address - City:VOLCANO
Mailing Address - State:HI
Mailing Address - Zip Code:96785-2121
Mailing Address - Country:US
Mailing Address - Phone:808-985-9874
Mailing Address - Fax:808-985-9874
Practice Address - Street 1:11-2860 ALII KANE ST
Practice Address - Street 2:
Practice Address - City:VOLCANO
Practice Address - State:HI
Practice Address - Zip Code:96785
Practice Address - Country:US
Practice Address - Phone:808-985-9874
Practice Address - Fax:808-985-9874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI631277-01Medicaid