Healthcare Provider Details

I. General information

NPI: 1972045425
Provider Name (Legal Business Name): HENRY COUNTY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WITTENBRAKER AVE
NEW CASTLE IN
47362-5034
US

IV. Provider business mailing address

300 WITTENBRAKER AVE
NEW CASTLE IN
47362-5034
US

V. Phone/Fax

Practice location:
  • Phone: 765-529-3804
  • Fax: 765-529-4575
Mailing address:
  • Phone: 765-529-3804
  • Fax: 765-529-4575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHRISTOPHER WILLIAMS
Title or Position: CEO
Credential:
Phone: 765-529-3804