MEDICARE: YOUNG MEN'S CHRISTIAN ASSOCIATION OF THE BLUE WATER AREA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator

General Provider Information

NPI Number	:	1407303266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNG MEN'S CHRISTIAN ASSOCIATION OF THE BLUE WATER AREA

Provider Business Mailing Address
First Line	:	1525 3RD ST
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-5482
Country	:	US
Telephone Number	:	810-987-6400
Fax Number	:	810-987-7251

Provider Business Practice Location Address
First Line	:	1525 3RD ST
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-5482
Country	:	US
Telephone Number	:	810-987-6400
Fax Number	:	810-987-7251

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MRS. DENISE MARIE BROOKS
Credential	:
Telephone Number	:	810-987-6400

Provider Enumeration Date	:	09/08/2016
Last Update Date	:	09/08/2016

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Directions to “YOUNG MEN'S CHRISTIAN ASSOCIATION OF THE BLUE WATER AREA ” Practice Location

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