Provider Demographics
NPI:1982207858
Name:DIVERSIFIED ISLAND INVESTMENT LTD.
Entity Type:Organization
Organization Name:DIVERSIFIED ISLAND INVESTMENT LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED BUSINESS AGENT
Authorized Official - Prefix:
Authorized Official - First Name:MARICHU
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-934-7733
Mailing Address - Street 1:PO BOX 6625
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-8931
Mailing Address - Country:US
Mailing Address - Phone:808-934-7733
Mailing Address - Fax:808-934-7744
Practice Address - Street 1:94-210 PUPUKAHI ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2649
Practice Address - Country:US
Practice Address - Phone:808-676-5751
Practice Address - Fax:808-677-1918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care