Martin Luther King Jr. Community Service Area Project

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

08002 Issued in IL

Legal business name

MARTIN LUTHER KING JR. COMMUNITY SERVICE AREA PROJECT

Practice address

555 N Court St Ste 204
Rockford, IL 61103-6898

Phone

(815) 233-9915

Fax

(815) 962-2180

NPI assigned

Mar 10, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Charles W Collins II, REV.

Title

Executive Director

Phone

(815) 233-9915

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1236643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236643200000",
    "number": "1619118304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 N COURT ST STE 204",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611036898",
            "telephone_number": "815-233-9915",
            "fax_number": "815-962-2180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 N COURT ST STE 204",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611036898",
            "telephone_number": "815-233-9915",
            "fax_number": "815-962-2180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN LUTHER KING JR. COMMUNITY SERVICE AREA PROJECT",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-10",
        "last_updated": "2009-03-10",
        "status": "A",
        "authorized_official_last_name": "COLLINS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "815-233-9915",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "REV."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IL",
            "license": "08002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary L Marshall, APN
• Rebecca Marshall
• Susan A Marshall, AUD
• Marshmallows Hope Nonprofit Organization Corp.
• Max Marsili
• Karyn Martin-Bohl, LCSW, RN, CADC
• Carlton Martin, LPC
• Carol A Martin, LCSW
• Jason Martin
• Jeffrey Martin, LCSW

• Community/Behavioral Health Agency in Rockford, IL
• Providers in Rockford, IL by specialty
• Community/Behavioral Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2009; 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.