Provider Demographics
NPI:1407303266
Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF THE BLUE WATER AREA
Entity Type:Organization
Organization Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF THE BLUE WATER AREA
Other - Org Name:BLUE WATER YMCA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-987-6400
Mailing Address - Street 1:1525 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-5482
Mailing Address - Country:US
Mailing Address - Phone:810-987-6400
Mailing Address - Fax:810-987-7251
Practice Address - Street 1:1525 3RD ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-5482
Practice Address - Country:US
Practice Address - Phone:810-987-6400
Practice Address - Fax:810-987-7251
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