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General NPI Number Information
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NPI Number | 1336684695
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Entity Type | Organization
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Legal Business Name | TWO RIVERS YOUNG MEN'S CHRISTIAN ASSOCIATION INC.
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Dates
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Enumeration Date | 12/22/2016
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Last Update Date | 12/22/2016
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Provider Practice Location Address
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Address Line | 2040 53RD ST
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City | MOLINE
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State | IL
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Zip | 61265-3650
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Country | US
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Telephone | 309-797-3945
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Fax | 309-277-1792
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Provider Business Mailing Address
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Address Line | 2040 53RD ST
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City | MOLINE
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State | IL
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Zip | 61265-3650
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Country | US
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Telephone | 309-797-3945
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Fax | 309-277-1792
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Authorized Official
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Title or Position | CEO
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Name | MR. MICHAEL WENNEKAMP
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Credential |
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Telephone | 309-797-3945
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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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