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General NPI Number Information
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NPI Number | 1952549255
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Entity Type | Organization
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Legal Business Name | MARION YOUTH DEVELOPMENT COUNCIL BOYS AND GIRLS CLUB MARION CO
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Dates
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Enumeration Date | 01/26/2009
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Last Update Date | 01/26/2009
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Provider Practice Location Address
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Address Line | 370 E MARK ST
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City | MARION
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State | OH
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Zip | 43302-2547
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Country | US
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Telephone | 740-387-3462
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Fax | 740-387-5518
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Provider Business Mailing Address
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Address Line | 370 E MARK ST PO BOX 207
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City | MARION
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State | OH
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Zip | 43302-2547
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Country | US
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Telephone | 740-387-3462
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Fax | 740-387-5518
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. CAROL DIMOFF
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Credential |
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Telephone | 740-387-3462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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