Provider Demographics
NPI:1528524014
Name:REGENERATIVE LIVING PRIVATE DUTY INC
Entity type:Organization
Organization Name:REGENERATIVE LIVING PRIVATE DUTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:KAZUO
Authorized Official - Last Name:HIRONAKA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:808-223-1989
Mailing Address - Street 1:1536 ALA PUUMALU STREET
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818
Mailing Address - Country:US
Mailing Address - Phone:808-223-1989
Mailing Address - Fax:866-306-3167
Practice Address - Street 1:1314 SOUTH KING STREET STE 853
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814
Practice Address - Country:US
Practice Address - Phone:808-223-1989
Practice Address - Fax:866-306-3167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty