Provider Demographics
NPI:1043433444
Name:KNOX CO. YMCA SENIOR SERVICE
Entity Type:Organization
Organization Name:KNOX CO. YMCA SENIOR SERVICE
Other - Org Name:BETTYE J. MCCORMICK SENIOR CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EX. DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NOLA
Authorized Official - Middle Name:E
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-882-2285
Mailing Address - Street 1:2009 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-5666
Mailing Address - Country:US
Mailing Address - Phone:812-882-2285
Mailing Address - Fax:812-882-2186
Practice Address - Street 1:2009 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-5666
Practice Address - Country:US
Practice Address - Phone:812-882-2285
Practice Address - Fax:812-882-2186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care