Healthcare Provider Details

I. General information

NPI: 1528515376
Provider Name (Legal Business Name): THE YOUNG MEN'S CHRISTIAN ASSOCIATION OF GREATER GRAND RAPIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 LAKE MICHIGAN DR NW
GRAND RAPIDS MI
49504-5600
US

IV. Provider business mailing address

475 LAKE MICHIGAN DR NW
GRAND RAPIDS MI
49504-5600
US

V. Phone/Fax

Practice location:
  • Phone: 616-855-9671
  • Fax:
Mailing address:
  • Phone: 616-855-9671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SCOTT LEWIS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 616-855-9602