Healthcare Provider Details

I. General information

NPI: 1043433444
Provider Name (Legal Business Name): KNOX CO. YMCA SENIOR SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 PROSPECT AVE
VINCENNES IN
47591-5666
US

IV. Provider business mailing address

2009 PROSPECT AVE
VINCENNES IN
47591-5666
US

V. Phone/Fax

Practice location:
  • Phone: 812-882-2285
  • Fax: 812-882-2186
Mailing address:
  • Phone: 812-882-2285
  • Fax: 812-882-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. NOLA E DAVIS
Title or Position: EX. DIRECTOR
Credential:
Phone: 812-882-2285