MEDICARE: YOUNG MEN'S CHRISTIAN ASSOCIATION OF SOUTH FLORIDA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator

General Provider Information

NPI Number	:	1306381330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNG MEN'S CHRISTIAN ASSOCIATION OF SOUTH FLORIDA, INC.

Provider Business Mailing Address
First Line	:	900 SE 3RD AVE
Second Line	:	SUITE 300
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-1118
Country	:	US
Telephone Number	:	954-334-9622
Fax Number	:

Provider Business Practice Location Address
First Line	:	3161 TAFT ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-4442
Country	:	US
Telephone Number	:	954-989-9622
Fax Number	:

Authorized Official
Title or Position	:	CHIEF STRATEGY OFFICER
Name	:	MARK RUSSELL
Credential	:
Telephone Number	:	407-587-6377

Provider Enumeration Date	:	12/29/2016
Last Update Date	:	12/29/2016

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