Provider Demographics
NPI:1326048406
Name:HOSPICE OF HILO
Entity Type:Organization
Organization Name:HOSPICE OF HILO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:RN MS
Authorized Official - Phone:808-969-1733
Mailing Address - Street 1:1011 WAIANUENUE AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2019
Mailing Address - Country:US
Mailing Address - Phone:808-969-1733
Mailing Address - Fax:808-961-7397
Practice Address - Street 1:1011 WAIANUENUE AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2019
Practice Address - Country:US
Practice Address - Phone:808-969-1733
Practice Address - Fax:808-969-4863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI055703-01Medicaid
HI0 006411-3OtherHI MED SVC ASSOC
HI0 006411-3OtherHI MED SVC ASSOC