Provider Demographics
NPI:1639628290
Name:DORCHESTER COUNTY FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.
Entity Type:Organization
Organization Name:DORCHESTER COUNTY FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.
Other - Org Name:DORCHESTER FAMILY YMCA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-221-0505
Mailing Address - Street 1:201 TALBOT AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-1500
Mailing Address - Country:US
Mailing Address - Phone:410-221-0505
Mailing Address - Fax:410-221-0514
Practice Address - Street 1:201 TALBOT AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1500
Practice Address - Country:US
Practice Address - Phone:410-221-0505
Practice Address - Fax:410-221-0514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty