Marshmallows Hope Nonprofit Organization Corp.

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

Legal business name

MARSHMALLOWS HOPE NONPROFIT ORGANIZATION CORP.

Practice address

1628 Temple LN
Rockford, IL 61112-1045

Phone

(847) 754-5770

NPI assigned

Nov 13, 2023

Last updated

Apr 2, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Robert Worth

Title

Systems Manager

Phone

(815) 501-8332

Specialties & licenses 2

Addresses

Tax ID family

Marshmallows Hope Nonprofit Organization Corp3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Marshmallows Hope Nonprofit Organization

  • Adolescent and Children Mental Health Clinic/Center
  • Springfield, IL
  • NPI 1487595757
  NPD tax ID
• Marshmallows Hope Nonprofit Organization Corp.

  • Adolescent and Children Mental Health Clinic/Center
  • Belleville, IL
  • NPI 1033001953
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kalab Polky

  • Clinical Social Worker
  • Rockford, IL
  • NPI 1306700539
  NPD
• Mark Oliveras

  • Marriage & Family Therapist
  • Belleville, IL
  • NPI 1851221527
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1699833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775088000000",
    "number": "1366216061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1628 TEMPLE LN",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611121045",
            "telephone_number": "888-277-4028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1628 TEMPLE LN",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611121045",
            "telephone_number": "847-754-5770"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2810 Frank Scott Pkwy W Ste 812",
            "address_purpose": "LOCATION",
            "city": "Belleville",
            "state": "IL",
            "postal_code": "622235007",
            "country_code": "US",
            "telephone_number": "888-277-4028",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MARSHMALLOWS HOPE NONPROFIT ORGANIZATION CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-13",
        "last_updated": "2026-04-02",
        "certification_date": "2026-04-02",
        "status": "A",
        "authorized_official_last_name": "WORTH",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "SYSTEMS MANAGER",
        "authorized_official_telephone_number": "815-501-8332"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John M Marshall Jr., D.D.S.
• Kyli Jordan Marshall, LCSW
• Mary L Marshall, APN
• Rebecca Marshall
• Susan A Marshall, AUD
• Max Marsili
• Martin Luther King Jr. Community Service Area Project
• Karyn Martin-Bohl, LCSW, RN, CADC
• Carlton Martin, LPC
• Carol A Martin, LCSW

• Adolescent and Children Mental Health Clinic/Center in Rockford, IL
• Providers in Rockford, IL by specialty
• Adolescent and Children Mental Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.