Provider Demographics
NPI:1790315380
Name:MARIE'S HOUSE OF HOPE INC.
Entity Type:Organization
Organization Name:MARIE'S HOUSE OF HOPE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IRVIN
Authorized Official - Middle Name:ALONZO
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:CMS, QMHS
Authorized Official - Phone:937-305-5119
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-0219
Mailing Address - Country:US
Mailing Address - Phone:937-305-5119
Mailing Address - Fax:937-529-4999
Practice Address - Street 1:332 LINWOOD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-4918
Practice Address - Country:US
Practice Address - Phone:937-529-4996
Practice Address - Fax:937-529-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health