Provider Demographics
NPI:1770033292
Name:MUSKEGON YOUNG MEN'S CHRISTIAN ASSOCIATION
Entity Type:Organization
Organization Name:MUSKEGON YOUNG MEN'S CHRISTIAN ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPOLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-722-9622
Mailing Address - Street 1:PO BOX 1667
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1667
Mailing Address - Country:US
Mailing Address - Phone:231-722-9622
Mailing Address - Fax:231-525-2890
Practice Address - Street 1:1115 3RD ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-2170
Practice Address - Country:US
Practice Address - Phone:231-722-9622
Practice Address - Fax:231-525-2890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty