Provider Demographics
NPI:1104192970
Name:MARIMED FOUNDATION
Entity Type:Organization
Organization Name:MARIMED FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QA AND HR DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANE
Authorized Official - Middle Name:
Authorized Official - Last Name:GANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-380-9964
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:808-239-2939
Mailing Address - Fax:808-397-3179
Practice Address - Street 1:47-292 AHAOLELO RD
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-4803
Practice Address - Country:US
Practice Address - Phone:808-239-2939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children