Provider Demographics
NPI:1700027422
Name:YMCA OF EASTERN UNION COUNTY
Entity Type:Organization
Organization Name:YMCA OF EASTERN UNION COUNTY
Other - Org Name:WISE ADULT SOCIAL DAY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:R
Authorized Official - Last Name:CANADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-355-9622
Mailing Address - Street 1:973A STUYVESANT AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6988
Mailing Address - Country:US
Mailing Address - Phone:908-687-2995
Mailing Address - Fax:908-688-6913
Practice Address - Street 1:973A STUYVESANT AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6988
Practice Address - Country:US
Practice Address - Phone:908-687-2995
Practice Address - Fax:908-688-6913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health