Provider Demographics
NPI:1841749975
Name:NORTHWESTERN CONNECTICUT YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.
Entity Type:Organization
Organization Name:NORTHWESTERN CONNECTICUT YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:BRISCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-489-3133
Mailing Address - Street 1:259 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-5315
Mailing Address - Country:US
Mailing Address - Phone:860-489-3133
Mailing Address - Fax:860-482-4853
Practice Address - Street 1:259 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-5315
Practice Address - Country:US
Practice Address - Phone:860-489-3133
Practice Address - Fax:860-482-4853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty