Provider Demographics
NPI:1629526819
Name:BOOTHBAY REGION YOUNG MEN'S CHRISTIAN ASSOCIATION
Entity Type:Organization
Organization Name:BOOTHBAY REGION YOUNG MEN'S CHRISTIAN ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:HAMBLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-633-2855
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:BOOTHBAY HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04538-0500
Mailing Address - Country:US
Mailing Address - Phone:207-633-2855
Mailing Address - Fax:207-633-6865
Practice Address - Street 1:261 TOWNSEND AVE
Practice Address - Street 2:
Practice Address - City:BOOTHBAY HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04538-1847
Practice Address - Country:US
Practice Address - Phone:207-633-2855
Practice Address - Fax:207-633-6865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty