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General NPI Number Information
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NPI Number | 1497290654
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Entity Type | Organization
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Legal Business Name | YOUNG MEN'S CHRISTIAN ASSOCIATION OF MONROE COUNTY, INC.
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Dates
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Enumeration Date | 12/27/2016
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Last Update Date | 12/27/2016
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Provider Practice Location Address
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Address Line | 2125 S HIGHLAND AVE
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City | BLOOMINGTON
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State | IN
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Zip | 47401-6773
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Country | US
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Telephone | 812-961-2175
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Fax | 888-829-1237
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Provider Business Mailing Address
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Address Line | 2125 S HIGHLAND AVE
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City | BLOOMINGTON
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State | IN
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Zip | 47401-6773
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Country | US
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Telephone | 812-961-2175
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Fax | 888-829-1237
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Authorized Official
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Title or Position | CEO
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Name | DR. JASON M. WINKLE
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Credential | PH.D.
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Telephone | 812-961-2371
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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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