Provider Demographics
NPI:1659827533
Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF GREATER FORT WAYNE, INC.
Entity Type:Organization
Organization Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF GREATER FORT WAYNE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:PASTURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-918-2148
Mailing Address - Street 1:347 W BERRY ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-2299
Mailing Address - Country:US
Mailing Address - Phone:260-422-6488
Mailing Address - Fax:260-422-6489
Practice Address - Street 1:347 W BERRY ST
Practice Address - Street 2:SUITE 500
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-2299
Practice Address - Country:US
Practice Address - Phone:260-422-6488
Practice Address - Fax:260-422-6489
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