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General NPI Number Information
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NPI Number | 1700321734
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Entity Type | Organization
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Legal Business Name | THE YOUNG MEN'S CHRISTIAN ASSOCIATION OF RACINE, WISCONSIN
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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 | 725 LAKE AVE
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City | RACINE
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State | WI
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Zip | 53403-1207
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Country | US
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Telephone | 262-634-1994
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Fax | 262-634-0401
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Provider Business Mailing Address
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Address Line | 725 LAKE AVE
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City | RACINE
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State | WI
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Zip | 53403-1207
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Country | US
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Telephone | 262-634-1994
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Fax | 262-634-0401
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. JEFFREY COLLEN
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Credential |
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Telephone | 262-634-1994
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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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