Full Life

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

License

N/A

Legal business name

FULL LIFE

Practice address

75-6082 Alii Dr Ste 8
Kailua Kona, HI 96740-2306

Phone

(808) 322-9333

Fax

(808) 322-9334

NPI assigned

Aug 1, 2006

Reactivated

Jan 12, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jim Kilgore

Title

Executive Director

Phone

(808) 322-9333

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612915200000",
    "number": "1851307375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75-6082 ALII DR STE 8",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "967402306",
            "telephone_number": "808-322-9333",
            "fax_number": "808-322-9334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75-6082 ALII DR STE 8",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "967402306",
            "telephone_number": "808-322-9333",
            "fax_number": "808-322-9334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL LIFE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2021-02-10",
        "certification_date": "2021-02-10",
        "deactivation_date": "2007-06-19",
        "reactivation_date": "2012-01-12",
        "status": "A",
        "authorized_official_last_name": "KILGORE",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "808-322-9333"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": "N/A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": "MEDICAID PROVIDER ID",
            "identifier": "516990-01",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.