Provider Demographics
NPI:1366216061
Name:MARSHMALLOWS HOPE NONPROFIT ORGANIZATION CORP.
Entity type:Organization
Organization Name:MARSHMALLOWS HOPE NONPROFIT ORGANIZATION CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:GABRIELA
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-754-5770
Mailing Address - Street 1:1628 TEMPLE LN
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61112-1045
Mailing Address - Country:US
Mailing Address - Phone:847-754-5770
Mailing Address - Fax:
Practice Address - Street 1:1628 TEMPLE LN
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61112-1045
Practice Address - Country:US
Practice Address - Phone:847-754-5770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health