Provider Demographics
NPI:1760932966
Name:HOSPICE OF HILO
Entity Type:Organization
Organization Name:HOSPICE OF HILO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:CHAMPAGNE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
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:808-969-4863
Practice Address - Street 1:1240 HONUA ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3205
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:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4154253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care