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General NPI Number Information
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NPI Number | 1306381330
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Entity Type | Organization
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Legal Business Name | YOUNG MEN'S CHRISTIAN ASSOCIATION OF SOUTH FLORIDA, INC.
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Dates
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Enumeration Date | 12/29/2016
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Last Update Date | 12/29/2016
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Provider Practice Location Address
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Address Line | 3161 TAFT ST
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City | HOLLYWOOD
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State | FL
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Zip | 33021-4442
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Country | US
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Telephone | 954-989-9622
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Fax |
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Provider Business Mailing Address
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Address Line | 900 SE 3RD AVE SUITE 300
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-1118
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Country | US
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Telephone | 954-334-9622
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Fax |
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Authorized Official
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Title or Position | CHIEF STRATEGY OFFICER
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Name | MARK RUSSELL
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Credential |
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Telephone | 407-587-6377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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