Provider Demographics
NPI:1811406648
Name:DOOR COUNTY YOUNG MEN'S CHRISTIAN ASSOCIATION INC
Entity Type:Organization
Organization Name:DOOR COUNTY YOUNG MEN'S CHRISTIAN ASSOCIATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BEERNTSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-743-4949
Mailing Address - Street 1:1900 MICHIGAN STREET
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235
Mailing Address - Country:US
Mailing Address - Phone:920-743-4949
Mailing Address - Fax:920-743-8812
Practice Address - Street 1:1900 MICHIGAN STREET
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235
Practice Address - Country:US
Practice Address - Phone:920-743-4949
Practice Address - Fax:920-743-8812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-25
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty