Provider Demographics
NPI:1922336791
Name:HIILANI HEALTH CORPORATION
Entity Type:Organization
Organization Name:HIILANI HEALTH CORPORATION
Other - Org Name:LIFE CONNECTIONS, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO/SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYMUNDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-800-7326
Mailing Address - Street 1:PO BOX 860327
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-0327
Mailing Address - Country:US
Mailing Address - Phone:808-800-7326
Mailing Address - Fax:808-621-0639
Practice Address - Street 1:108 OLOKANI PL
Practice Address - Street 2:2ND FL
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-4812
Practice Address - Country:US
Practice Address - Phone:808-621-2670
Practice Address - Fax:808-621-0639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-06
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
HI251E00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI639007Medicaid