Provider Demographics
NPI:1770030785
Name:THE PENINSULA METROPOLITAN YOUNG MEN'S CHRISTIAN ASSOCIATION
Entity Type:Organization
Organization Name:THE PENINSULA METROPOLITAN YOUNG MEN'S CHRISTIAN ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-223-7925
Mailing Address - Street 1:41 OLD OYSTER POINT RD STE C
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-7177
Mailing Address - Country:US
Mailing Address - Phone:757-223-7925
Mailing Address - Fax:757-223-7926
Practice Address - Street 1:101 LONG GREEN BLVD
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-4139
Practice Address - Country:US
Practice Address - Phone:757-867-3300
Practice Address - Fax:757-867-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty