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General NPI Number Information
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NPI Number | 1588111512
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Entity Type | Organization
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Legal Business Name | YOUNG MEN'S CHRISTIAN ASSOCIATION OF FOND DU LAC, WISCONSIN, INC.
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Dates
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Enumeration Date | 09/07/2016
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Last Update Date | 09/07/2016
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Provider Practice Location Address
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Address Line | 90 W 2ND ST
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City | FOND DU LAC
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State | WI
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Zip | 54935-4141
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Country | US
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Telephone | 920-921-3330
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Fax | 920-921-3376
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Provider Business Mailing Address
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Address Line | 90 W 2ND ST
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City | FOND DU LAC
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State | WI
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Zip | 54935-4141
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Country | US
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Telephone | 920-921-3330
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Fax | 920-921-3376
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Authorized Official
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Title or Position | CEO
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Name | GREG GILES
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Credential |
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Telephone | 920-921-3330
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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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