Healthcare Provider Details

I. General information

NPI: 1831609577
Provider Name (Legal Business Name): THE WATERBURY YOUNG MEN'S CHRISTIAN ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 10/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 W MAIN ST
WATERBURY CT
06702-2005
US

IV. Provider business mailing address

136 W MAIN ST
WATERBURY CT
06702-2005
US

V. Phone/Fax

Practice location:
  • Phone: 203-754-9622
  • Fax: 203-754-9095
Mailing address:
  • Phone: 203-754-9622
  • Fax: 203-754-9095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES O'ROURKE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 203-754-9622