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General NPI Number Information
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NPI Number | 1659827533
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Entity Type | Organization
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Legal Business Name | YOUNG MEN'S CHRISTIAN ASSOCIATION OF GREATER FORT WAYNE, INC.
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Dates
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Enumeration Date | 08/30/2016
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Last Update Date | 08/30/2016
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Provider Practice Location Address
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Address Line | 347 W BERRY ST SUITE 500
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City | FORT WAYNE
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State | IN
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Zip | 46802-2299
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Country | US
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Telephone | 260-422-6488
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Fax | 260-422-6489
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Provider Business Mailing Address
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Address Line | 347 W BERRY ST SUITE 500
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City | FORT WAYNE
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State | IN
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Zip | 46802-2299
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Country | US
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Telephone | 260-422-6488
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Fax | 260-422-6489
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. MARTIN L PASTURA
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Credential |
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Telephone | 260-918-2148
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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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