Provider Demographics
NPI:1578071551
Name:MERCER COUNTY FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION OF ALEDO, ILLIN
Entity Type:Organization
Organization Name:MERCER COUNTY FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION OF ALEDO, ILLIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-582-5101
Mailing Address - Street 1:401 SW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:IL
Mailing Address - Zip Code:61231
Mailing Address - Country:US
Mailing Address - Phone:309-582-5101
Mailing Address - Fax:309-582-7222
Practice Address - Street 1:401 SW 2ND AVE
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:IL
Practice Address - Zip Code:61231
Practice Address - Country:US
Practice Address - Phone:309-582-5101
Practice Address - Fax:309-582-7222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty