Provider Demographics
NPI:1801044094
Name:HILO MEDICAL CENTER HOME HEALTH EPSDT
Entity type:Organization
Organization Name:HILO MEDICAL CENTER HOME HEALTH EPSDT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHURRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-974-4729
Mailing Address - Street 1:1190 WAIANUENUE AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2020
Mailing Address - Country:US
Mailing Address - Phone:808-974-7720
Mailing Address - Fax:808-974-4718
Practice Address - Street 1:1190 WAIANUENUE AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2020
Practice Address - Country:US
Practice Address - Phone:808-974-7720
Practice Address - Fax:808-974-4718
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HILO MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOHCA# HHA-2251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI53345701Medicaid