Provider Demographics
NPI:1356409270
Name:HOSPICE OF KONA, INC.
Entity type:Organization
Organization Name:HOSPICE OF KONA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFI
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:VARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-324-7700
Mailing Address - Street 1:PO BOX 4130
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96745-4130
Mailing Address - Country:US
Mailing Address - Phone:808-324-7700
Mailing Address - Fax:808-331-0767
Practice Address - Street 1:75-5925 WALUA ROAD
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740
Practice Address - Country:US
Practice Address - Phone:808-324-7700
Practice Address - Fax:808-331-0767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI24751001Medicaid
HI9381-5OtherPROVIDER ID
HI024751001Medicaid
HI9381-5OtherPROVIDER ID
HI24751001Medicaid