Provider Demographics
NPI:1750832077
Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF BERWYN-CICERO
Entity Type:Organization
Organization Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF BERWYN-CICERO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-749-0606
Mailing Address - Street 1:2947 OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3048
Mailing Address - Country:US
Mailing Address - Phone:708-749-0606
Mailing Address - Fax:708-749-7793
Practice Address - Street 1:2947 OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3048
Practice Address - Country:US
Practice Address - Phone:708-749-0606
Practice Address - Fax:708-749-7793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty