Provider Demographics
NPI:1760276174
Name:REJUVENATE HAWAII
Entity type:Organization
Organization Name:REJUVENATE HAWAII
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, ANESTHESIOLOGIST EMPLOYEE
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BIANCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-765-0378
Mailing Address - Street 1:PO BOX 260
Mailing Address - Street 2:
Mailing Address - City:KURTISTOWN
Mailing Address - State:HI
Mailing Address - Zip Code:96760-0260
Mailing Address - Country:US
Mailing Address - Phone:808-346-1854
Mailing Address - Fax:
Practice Address - Street 1:82 PUUHONU PL STE 100
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2010
Practice Address - Country:US
Practice Address - Phone:808-969-9669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-09
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain