Provider Demographics
NPI:1891051850
Name:HOSPICE OF HILO
Entity Type:Organization
Organization Name:HOSPICE OF HILO
Other - Org Name:KUPU CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
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 1:590 KAPIOLANI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720
Practice Address - Country:US
Practice Address - Phone:808-969-1733
Practice Address - Fax:808-961-7397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0 006411-3OtherHAWAII MEDICAL SERVICES ASSOC.
HI055703-01Medicaid
HI0 006411-3OtherHAWAII MEDICAL SERVICES ASSOC.