Provider Demographics
NPI:1659379980
Name:HOSPICE OF KONA INC
Entity Type:Organization
Organization Name:HOSPICE OF KONA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-334-0334
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96745-0217
Mailing Address - Country:US
Mailing Address - Phone:808-334-0334
Mailing Address - Fax:808-334-0365
Practice Address - Street 1:74-5094 PALANI RD
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-9654
Practice Address - Country:US
Practice Address - Phone:808-334-0334
Practice Address - Fax:808-334-0365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI121505Medicare ID - Type Unspecified