MEDICARE: YOUNG MEN'S CHRISTIAN ASSOCIATION OF ROANOKE VALLEY, 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	:	1700333721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNG MEN'S CHRISTIAN ASSOCIATION OF ROANOKE VALLEY, INC.

Provider Business Mailing Address
First Line	:	PO BOX 2130
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24009-2130
Country	:	US
Telephone Number	:	540-342-9622
Fax Number	:	540-345-0730

Provider Business Practice Location Address
First Line	:	1126 KIME LN
Second Line	:
City	:	SALEM
State	:	VA
Zip	:	24153-5301
Country	:	US
Telephone Number	:	540-387-9622
Fax Number	:	540-389-7152

Authorized Official
Title or Position	:	CEO
Name	:	MARK JOHNSON
Credential	:
Telephone Number	:	540-527-9622

Provider Enumeration Date	:	09/07/2016
Last Update Date	:	02/17/2017

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