Healthcare Provider Details

I. General information

NPI: 1184174088
Provider Name (Legal Business Name): CENTRAL LINCOLN COUNTY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 MAIN STREET
DAMARISCOTTA ME
04543
US

IV. Provider business mailing address

PO BOX 787
DAMARISCOTTA ME
04543-0787
US

V. Phone/Fax

Practice location:
  • Phone: 207-563-9622
  • Fax: 207-633-6865
Mailing address:
  • Phone: 207-563-9622
  • Fax: 207-633-6865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MEAGAN HAMBLETT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 207-563-9622