Provider Demographics
NPI:1558467159
Name:KILAUEA REHAB, INC.
Entity Type:Organization
Organization Name:KILAUEA REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:TULMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:808-961-0058
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96721-0487
Mailing Address - Country:US
Mailing Address - Phone:808-961-3505
Mailing Address - Fax:808-935-6895
Practice Address - Street 1:333 KILAUEA AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3013
Practice Address - Country:US
Practice Address - Phone:808-961-3505
Practice Address - Fax:808-961-6505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH100409OtherGROUP PIN NUMBER