Healthcare Provider Details

I. General information

NPI: 1205297827
Provider Name (Legal Business Name): YOUNG MEN'S CHRISTIAN ASSOCIATION OF NORTHERN MIDDLESEX COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2016
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 UNION ST
MIDDLETOWN CT
06457-3427
US

IV. Provider business mailing address

99 UNION ST
MIDDLETOWN CT
06457-3427
US

V. Phone/Fax

Practice location:
  • Phone: 860-347-6907
  • Fax:
Mailing address:
  • Phone: 860-347-6907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. MICHELE RULNICK
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 860-343-6217