Provider Demographics
NPI:1720535909
Name:PHILADELPHIA FREEDOM VALLEY YOUNG MEN'S CHRISTIAN ASSOCIATION
Entity Type:Organization
Organization Name:PHILADELPHIA FREEDOM VALLEY YOUNG MEN'S CHRISTIAN ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-963-3704
Mailing Address - Street 1:400 FAYETTE ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1904
Mailing Address - Country:US
Mailing Address - Phone:267-592-4383
Mailing Address - Fax:
Practice Address - Street 1:891 N EAGLE RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2127
Practice Address - Country:US
Practice Address - Phone:610-649-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty