Provider Demographics
NPI:1063445690
Name:HOSPICE MAUI, INC
Entity Type:Organization
Organization Name:HOSPICE MAUI, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DORECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGOY
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:808-244-5555
Mailing Address - Street 1:400 MAHALANI ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2547
Mailing Address - Country:US
Mailing Address - Phone:808-244-5555
Mailing Address - Fax:808-244-5557
Practice Address - Street 1:400 MAHALANI ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2547
Practice Address - Country:US
Practice Address - Phone:808-244-5555
Practice Address - Fax:808-244-5557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIW40836976-01251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00089797OtherHMSA PROVIDER NUMBER
HI06921101Medicaid
HI00089797OtherHMSA PROVIDER NUMBER
HI06921101Medicaid