Provider Demographics
NPI:1730634890
Name:GREATER KINGSPORT FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.
Entity Type:Organization
Organization Name:GREATER KINGSPORT FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-765-9901
Mailing Address - Street 1:1840 MEADOWVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-7480
Mailing Address - Country:US
Mailing Address - Phone:423-247-9622
Mailing Address - Fax:423-578-2199
Practice Address - Street 1:1840 MEADOWVIEW PKWY
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7480
Practice Address - Country:US
Practice Address - Phone:423-247-9622
Practice Address - Fax:423-578-2199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty