MARIMED FOUNDATION FOR ISLAND HEALTH CARE TRAINING (NPI# 1871797381) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871797381 |
| Entity Type | Organization |
| Organization Name | MARIMED FOUNDATION FOR ISLAND HEALTH CARE TRAINING |
| Practice Address |
45-021 Likeke Pl Kaneohe HI 96744-2426 |
| Practice Telephone | 8082362288 |
| Practice Fax Number | 8082351074 |
| Mailing Telephone | 8082362288 |
| Mailing Fax Number | 8082351074 |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. MATTHEW ALAN CLAYBAUGH (PRESIDENT CEO) |
| Authorized Official Telephone | 8082362288 |
| Authorized Official Credential | PH.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | HI | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740454594 | Marimed Foundation for Island Health Care Training | Substance Abuse Rehabilitation Facility | 45-021 Likeke Pl, Kaneohe, HI 96744-2426 | 2008-04-14 |
| Street Address |
45-021 LIKEKE PL |
| City | KANEOHE |
| State | HI |
| Zip Code | 96744-2426 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336683648 | Richard Hauoli Crowell | Marriage & Family Therapist | 45-021 Likeke Pl, Kaneohe, HI 96744-2426 | 2016-12-06 |
| 1912375593 | Shealin Johnson | Marriage & Family Therapist | 45-021 Likeke Pl, Kaneohe, HI 96744-2426 | 2015-09-12 |
| 1104242668 | Jazzmina Moore | Registered Nurse | 45-021 Likeke Pl, Kaneohe, HI 96744-2426 | 2014-03-07 |
| 1982962452 | Michael John Moskal | Counselor | 45-021 Likeke Pl, Kaneohe, HI 96744-2426 | 2012-05-02 |
| 1215203286 | Deborah Elaine Boltz | Counselor | 45-021 Likeke Pl, Kaneohe, HI 96744-2426 | 2012-03-23 |
| 1770812059 | Anthony Ferro | Counselor | 45-021 Likeke Pl, Kaneohe, HI 96744-2426 | 2009-12-15 |
| 1942434246 | Tara Dixon | Counselor | 45-021 Likeke Pl, Kaneohe, HI 96744-2426 | 2009-05-14 |
| 1447499124 | Chris Enomoto | Community Based Residential Treatment Facility, Mental Illness | 45-021 Likeke Pl, Kaneohe, HI 96744-2426 | 2009-02-19 |
| 1770728792 | Helen Kahai | Social Worker | 45-021 Likeke Pl, Kaneohe, HI 96744-2426 | 2008-12-04 |
| 1528219482 | Dane Ganes | Counselor | 45-021 Likeke Pl, Kaneohe, HI 96744-2426 | 2008-10-08 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740820026 | Kathleen Rhoads Merriam | Counselor | Wiindward Oahu Treatment Services Section, 45-691 Keaahala Road, Bldg. F, Kaneohe, HI 96744 | 2020-01-14 |
| 1760945430 | Claudia Isabella Sema | Counselor | Hina Mauka, 47-333 Hui Iwastreet, Suite # 11, Kaneohe, HI 96744 | 2019-04-10 |
| 1497217251 | The Evangelical Lutheran Good Samaritan Society | In Home Supportive Care | 45-090 Namoku St. Cottage H, Kaneohe, HI 96744 | 2019-04-02 |
| 1386117778 | Kasse-ann Akemi Kiriu-dela Cruz | Behavior Technician | 45-955 Kamehameha Hwy., Kaneohe, HI 96744 | 2019-01-08 |
| 1689177826 | Alexander P Dunnum | Military Hospital | 1/12 Battalion Aid Station, 6894r Selby St, Kaneohe, HI 96744 | 2018-03-14 |
| 1225545056 | Corinna Aquino | Behavior Technician | 95-955 Kamehameha Hwy., #404, Kaneohe, HI 96744 | 2018-01-02 |
| 1861901704 | Jayna L. Chung, D.d.s. | Dentist | 46-001 Kamehamcha Hwy Suite 418, Kaneohe, HI 96744 | 2017-09-22 |
| 1366981938 | Andrew Ho'ola'iku Johnson | Dentist | 45-943 Kamehameha Hwy Ste 201, Kaneohe, HI 96744 | 2017-02-15 |
| 1669829099 | William Robert Sicilia | Student in an Organized Health Care Education/Training Program | 46-056 Kamehameha Highway, Suite 288, Kaneohe, HI 96744 | 2016-05-16 |
| 1558729434 | Douglas Frisbie | Marriage & Family Therapist | 45-21 Likeke Place, Kaneohe, HI 96744 | 2016-02-05 |
| Find all providers in zip 96744 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922151026 | Po Ailani | Community Based Residential Treatment Facility, Mental Illness | 45-567 Pahia Road, Kaneohe, HI 96744 | 2007-01-19 |
| 1013336213 | Poailani,inc | Community Based Residential Treatment Facility, Mental Illness | 45-567 Pahia Rd, Kaneohe, HI 96744-3318 | 2014-04-15 |
| 1447499124 | Chris Enomoto | Community Based Residential Treatment Facility, Mental Illness | 45-021 Likeke Pl, Kaneohe, HI 96744-2426 | 2009-02-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386270551 | Stephanie Makino-kahuli | Community Based Residential Treatment Facility, Mental Illness | 1786 Kinoole St, Hilo, HI 96720-5245 | 2020-03-19 |
| 1073969036 | Armen Armaghanyan | Community Based Residential Treatment Facility, Mental Illness | 896 Kumukoa St, Hilo, HI 96720-4028 | 2016-05-09 |
| 1922427129 | Poailani, Inc | Community Based Residential Treatment Facility, Mental Illness | 553 Kawainui St, Kailua, HI 96734-2408 | 2014-04-15 |
| 1194140251 | Care Hawaii, Inc. | Community Based Residential Treatment Facility, Mental Illness | 1668 Hoohulu St, Pearl City, HI 96782-1805 | 2014-02-26 |
| 1467877522 | Care Hawaii, Inc. | Community Based Residential Treatment Facility, Mental Illness | 98-839 Kaamilo St, Aiea, HI 96701-3446 | 2014-02-26 |
| 1932524568 | Poilani, Inc | Community Based Residential Treatment Facility, Mental Illness | 74 Kihapai St, Kailua, HI 96734-2612 | 2014-02-18 |
| 1144659020 | Nova Luna, Inc. | Community Based Residential Treatment Facility, Mental Illness | 470 Lilihua Pl, Wailuku, HI 96793-1313 | 2013-11-01 |
| 1518225531 | Small Kine Polynesian | Community Based Residential Treatment Facility, Mental Illness | 55-025 Lanihuli St, Laie, HI 96762-1225 | 2012-04-27 |
| 1598057275 | Po'ailani, Inc. | Community Based Residential Treatment Facility, Mental Illness | 970 N Kalaheo Ave Ste A102, Kailua, HI 96734-1868 | 2011-05-12 |
| 1154958395 | Kekuamakana C Lewis | Community Based Residential Treatment Facility, Mental Illness | 1786 Kinoole St, Hilo, HI 96720-5245 | 2020-03-26 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.