Provider Demographics
NPI:1437692670
Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF VALPARAISO, INDIANA, INC.
Entity Type:Organization
Organization Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF VALPARAISO, INDIANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WANEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-462-4185
Mailing Address - Street 1:1201 CUMBERLAND CROSSING DRIVE
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383
Mailing Address - Country:US
Mailing Address - Phone:219-462-4185
Mailing Address - Fax:219-477-4720
Practice Address - Street 1:1201 CUMBERLAND CROSSING DRIVE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383
Practice Address - Country:US
Practice Address - Phone:219-462-4185
Practice Address - Fax:219-477-4720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty