Provider Demographics
NPI:1689120552
Name:JOLIET YOUNG MEN'S CHRISTIAN ASSOCIATION
Entity Type:Organization
Organization Name:JOLIET YOUNG MEN'S CHRISTIAN ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-729-9638
Mailing Address - Street 1:749 HOUBOLT RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-9319
Mailing Address - Country:US
Mailing Address - Phone:815-729-9638
Mailing Address - Fax:815-729-9629
Practice Address - Street 1:15120 W WALLIN DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-2557
Practice Address - Country:US
Practice Address - Phone:815-267-8600
Practice Address - Fax:815-267-8601
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