Provider Demographics
NPI:1346742764
Name:SUPERIOR DOUGLAS COUNTY FAMILY YMCA
Entity Type:Organization
Organization Name:SUPERIOR DOUGLAS COUNTY FAMILY YMCA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:STENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-392-5611
Mailing Address - Street 1:9 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-5201
Mailing Address - Country:US
Mailing Address - Phone:715-392-5611
Mailing Address - Fax:
Practice Address - Street 1:9 N 21ST ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-5201
Practice Address - Country:US
Practice Address - Phone:715-392-5611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable