Provider Demographics
NPI:1417408121
Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF LA PORTE IND
Entity Type:Organization
Organization Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF LA PORTE IND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERCHEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-325-9622
Mailing Address - Street 1:901 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-3504
Mailing Address - Country:US
Mailing Address - Phone:219-325-9622
Mailing Address - Fax:219-325-3600
Practice Address - Street 1:901 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3504
Practice Address - Country:US
Practice Address - Phone:219-325-9622
Practice Address - Fax:219-325-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty