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General NPI Number Information
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NPI Number | 1871797381
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Entity Type | Organization
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Legal Business Name | MARIMED FOUNDATION FOR ISLAND HEALTH CARE TRAINING
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 45-021 LIKEKE PL
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City | KANEOHE
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State | HI
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Zip | 96744-2426
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Country | US
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Telephone | 808-236-2288
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Fax | 808-235-1074
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Provider Business Mailing Address
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Address Line | 45-021 LIKEKE PL
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City | KANEOHE
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State | HI
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Zip | 96744-2426
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Country | US
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Telephone | 808-236-2288
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Fax | 808-235-1074
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | DR. MATTHEW ALAN CLAYBAUGH
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Credential | PH.D.
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Telephone | 808-236-2288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State | HI
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