12D2102822 CLIA NUMBER - HILO SNF FKA LEGACY OF HILO

Laboratory Demographics

  • CLIA Code: 12D2102822
  • Facility Name: HILO SNF FKA LEGACY OF HILO
  • Facility Address: 563 KAUMANA DRIVE
    HILO, HI
    ZIP 96720
  • Facility Phone: 808 498-0100
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: JULIE GUSCETTE BRENNA
  • NPI Number: 1215573381
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 12D2102822
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name HILO SNF FKA LEGACY OF HILO
Street 563 KAUMANA DRIVE
City HILO
State HI
ZIP 96720
Phone 808 498-0100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/29/2025
Certificate Expiration Date 9/28/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director JULIE GUSCETTE BRENNA

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This page was last updated on: 9/29/2025