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General NPI Number Information
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NPI Number | 1033001953
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Entity Type | Organization
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Legal Business Name | MARSHMALLOWS HOPE NONPROFIT ORGANIZATION CORP.
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Dates
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Enumeration Date | 07/16/2025
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 2810 FRANK SCOTT PKWY W STE 812
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City | BELLEVILLE
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State | IL
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Zip | 62223-5007
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Country | US
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Telephone | 888-277-4028
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Fax | 815-246-0245
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Provider Business Mailing Address
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Address Line | 1628 TEMPLE LN
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City | ROCKFORD
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State | IL
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Zip | 61112-1045
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Country | US
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Telephone | 888-277-4028
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | ROBERT WORTH
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Credential |
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Telephone | 888-277-4028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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