MEDICARE: THE YOUNG MEN'S CHRISTIAN ASSOCIATION OF THE TRIANGLE AREA, 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	:	1619425949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE YOUNG MEN'S CHRISTIAN ASSOCIATION OF THE TRIANGLE AREA, INC.

Provider Business Mailing Address
First Line	:	801 CORPORATE CENTER DR
Second Line	:	SUITE 200
City	:	RALEIGH
State	:	NC
Zip	:	27607-5486
Country	:	US
Telephone Number	:	919-719-9622
Fax Number	:	919-719-9634

Provider Business Practice Location Address
First Line	:	1603 HILLSBOROUGH ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27605-1638
Country	:	US
Telephone Number	:	919-832-9622
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. BRYAN A HUFFMAN
Credential	:
Telephone Number	:	919-719-9622

Provider Enumeration Date	:	09/15/2016
Last Update Date	:	09/15/2016

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