Provider Demographics
NPI:1740454594
Name:MARIMED FOUNDATION FOR ISLAND HEALTH CARE TRAINING
Entity type:Organization
Organization Name:MARIMED FOUNDATION FOR ISLAND HEALTH CARE TRAINING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEONA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOO
Authorized Official - Suffix:
Authorized Official - Credentials:
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:808-247-4032
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:808-247-4032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIW20365520-013245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children