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General NPI Number Information
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NPI Number | 1700333721
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Entity Type | Organization
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Legal Business Name | YOUNG MEN'S CHRISTIAN ASSOCIATION OF ROANOKE VALLEY, INC.
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Dates
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Enumeration Date | 09/07/2016
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Last Update Date | 02/17/2017
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Provider Practice Location Address
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Address Line | 1126 KIME LN
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City | SALEM
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State | VA
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Zip | 24153-5301
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Country | US
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Telephone | 540-387-9622
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Fax | 540-389-7152
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Provider Business Mailing Address
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Address Line | PO BOX 2130
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City | ROANOKE
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State | VA
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Zip | 24009-2130
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Country | US
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Telephone | 540-342-9622
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Fax | 540-345-0730
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Authorized Official
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Title or Position | CEO
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Name | MARK JOHNSON
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Credential |
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Telephone | 540-527-9622
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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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