Basic Information
| Provider Information | |||||||||
| NPI: | 1376600098 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HILO MEDICAL INVESTORS LTD. | ||||||||
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| OtherOrganizationName: | HALE ANUENUE RESTORATIVE CARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1333 WAIANUENUE AVE | ||||||||
| Address2: | |||||||||
| City: | HILO | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967201202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089616644 | ||||||||
| FaxNumber: | 8089616630 | ||||||||
| Practice Location | |||||||||
| Address1: | 3001 KEITH ST NW | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373123713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234735751 | ||||||||
| FaxNumber: | 4233398342 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 01/05/2015 | ||||||||
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| AuthorizedOfficialLastName: | CROSS | ||||||||
| AuthorizedOfficialFirstName: | CINDY | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSISTANT SECRETARY FOR LCCA, MGR | ||||||||
| AuthorizedOfficialTelephone: | 4234735867 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 52-N | HI | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 083742 | 05 | HI | MEDICAID |