Provider Demographics
NPI:1871797381
Name:MARIMED FOUNDATION FOR ISLAND HEALTH CARE TRAINING
Entity type:Organization
Organization Name:MARIMED FOUNDATION FOR ISLAND HEALTH CARE TRAINING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:CLAYBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-236-2288
Mailing Address - Street 1:45-021 LIKEKE PL
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2426
Mailing Address - Country:US
Mailing Address - Phone:808-236-2288
Mailing Address - Fax:808-235-1074
Practice Address - Street 1:45-021 LIKEKE PL
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-2426
Practice Address - Country:US
Practice Address - Phone:808-236-2288
Practice Address - Fax:808-235-1074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness