MEDICARE: YOUNG MEN'S CHRISTIAN ASSOCIATION OF BERWYN-CICERO

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	:	1750832077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNG MEN'S CHRISTIAN ASSOCIATION OF BERWYN-CICERO

Provider Business Mailing Address
First Line	:	2947 OAK PARK AVE
Second Line	:
City	:	BERWYN
State	:	IL
Zip	:	60402-3048
Country	:	US
Telephone Number	:	708-749-0606
Fax Number	:	708-749-7793

Provider Business Practice Location Address
First Line	:	2947 OAK PARK AVE
Second Line	:
City	:	BERWYN
State	:	IL
Zip	:	60402-3048
Country	:	US
Telephone Number	:	708-749-0606
Fax Number	:	708-749-7793

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR/CEO
Name	:	JAMIE KUCERA
Credential	:
Telephone Number	:	708-749-0606

Provider Enumeration Date	:	10/21/2016
Last Update Date	:	10/21/2016

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