Provider Demographics
NPI:1215573381
Name:HILO SNF LLC
Entity Type:Organization
Organization Name:HILO SNF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:HATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-791-4496
Mailing Address - Street 1:45-181 WAIKALUA RD
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2765
Mailing Address - Country:US
Mailing Address - Phone:808-247-0003
Mailing Address - Fax:
Practice Address - Street 1:563 KAUMANA DR
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-1812
Practice Address - Country:US
Practice Address - Phone:808-498-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-22
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility