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General NPI Number Information
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NPI Number | 1821547951
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Entity Type | Organization
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Legal Business Name | GREEN COUNTY FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION
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Dates
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Enumeration Date | 09/30/2016
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Last Update Date | 09/30/2016
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Provider Practice Location Address
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Address Line | 1307 2ND ST
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City | MONROE
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State | WI
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Zip | 53566-1169
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Country | US
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Telephone | 608-325-2003
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Fax | 608-325-2058
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Provider Business Mailing Address
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Address Line | 1307 2ND ST
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City | MONROE
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State | WI
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Zip | 53566-1169
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Country | US
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Telephone | 608-325-2003
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Fax | 608-325-2058
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. AARON K PHILLIPS
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Credential |
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Telephone | 608-325-2003
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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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