Provider Demographics
NPI:1134395742
Name:MILLS COUNTY YMCA SPECIAL OLYMPICS/ADAPTIVE PROGRAM
Entity type:Organization
Organization Name:MILLS COUNTY YMCA SPECIAL OLYMPICS/ADAPTIVE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:A
Authorized Official - Last Name:ORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-527-4352
Mailing Address - Street 1:12 N HAZEL ST
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51534-1718
Mailing Address - Country:US
Mailing Address - Phone:712-520-4443
Mailing Address - Fax:
Practice Address - Street 1:110 SIVERS RD
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IA
Practice Address - Zip Code:51534-1561
Practice Address - Country:US
Practice Address - Phone:712-527-4352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YMCA OF METRO OMAHA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-03
Last Update Date:2008-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services