Provider Demographics
NPI:1669995635
Name:THE FIRECRACKER FOUNDATION
Entity type:Organization
Organization Name:THE FIRECRACKER FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TASHMICA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOROK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-242-5467
Mailing Address - Street 1:2450 DELHI COMMERCE DR STE 9
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-2193
Mailing Address - Country:US
Mailing Address - Phone:517-242-5467
Mailing Address - Fax:
Practice Address - Street 1:2450 DELHI COMMERCE DR STE 9
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-2193
Practice Address - Country:US
Practice Address - Phone:517-242-5467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health