Provider Demographics
NPI:1023564861
Name:SOUTH SHORE YOUNG MEN'S CHRISTIAN ASSOCIATION
Entity Type:Organization
Organization Name:SOUTH SHORE YOUNG MEN'S CHRISTIAN ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-264-9400
Mailing Address - Street 1:141 LONGWATER DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061
Mailing Address - Country:US
Mailing Address - Phone:781-264-9400
Mailing Address - Fax:617-328-0564
Practice Address - Street 1:91 LONGWATER CIR
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1646
Practice Address - Country:US
Practice Address - Phone:617-479-8500
Practice Address - Fax:617-328-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty