Provider Demographics
NPI:1306393178
Name:ITASCA COUNTY FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.
Entity Type:Organization
Organization Name:ITASCA COUNTY FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-327-8808
Mailing Address - Street 1:400 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-3784
Mailing Address - Country:US
Mailing Address - Phone:218-327-1161
Mailing Address - Fax:218-327-8813
Practice Address - Street 1:400 RIVER RD
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-3784
Practice Address - Country:US
Practice Address - Phone:218-327-1161
Practice Address - Fax:218-327-8813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty