Healthcare Provider Details

I. General information

NPI: 1932644119
Provider Name (Legal Business Name): YOUNG MEN'S CHRISTIAN ASSOCIATION OF SOUTHEASTERN NORTH CAROLINA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2016
Last Update Date: 12/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 S KERR AVE
WILMINGTON NC
28403-1416
US

IV. Provider business mailing address

3825 MARKET ST
WILMINGTON NC
28403-1453
US

V. Phone/Fax

Practice location:
  • Phone: 910-251-9622
  • Fax: 910-251-2509
Mailing address:
  • Phone: 910-251-9622
  • Fax: 910-251-2509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DICK JONES
Title or Position: PRESIDENT & CEO
Credential:
Phone: 910-251-9622