Provider Demographics
NPI:1629524699
Name:SCOTT COUNTY FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION
Entity Type:Organization
Organization Name:SCOTT COUNTY FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION
Other - Org Name:SCOTT COUNTY FAMILY Y
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-322-7171
Mailing Address - Street 1:606 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52801-1009
Mailing Address - Country:US
Mailing Address - Phone:563-345-4246
Mailing Address - Fax:563-345-6448
Practice Address - Street 1:606 W 2ND ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52801-1009
Practice Address - Country:US
Practice Address - Phone:563-345-4246
Practice Address - Fax:563-345-6448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty