Healthcare Provider Details

I. General information

NPI: 1043760994
Provider Name (Legal Business Name): YOUNG MEN'S CHRISTIAN ASSOCIATION OF LEBANON, PENNSYLVANIA
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

201 N 7TH ST
LEBANON PA
17046-5007
US

IV. Provider business mailing address

201 N 7TH ST
LEBANON PA
17046-5007
US

V. Phone/Fax

Practice location:
  • Phone: 717-273-2691
  • Fax: 717-376-0345
Mailing address:
  • Phone: 717-273-2691
  • Fax: 717-376-0345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. PHILLIP TIPTON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 717-376-1380