Provider Demographics
NPI:1255882973
Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF GREATER SPRINGFIELD
Entity type:Organization
Organization Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF GREATER SPRINGFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEXTER
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-206-5529
Mailing Address - Street 1:275 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3562
Mailing Address - Country:US
Mailing Address - Phone:413-739-6951
Mailing Address - Fax:413-736-4869
Practice Address - Street 1:275 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3562
Practice Address - Country:US
Practice Address - Phone:413-206-5506
Practice Address - Fax:413-736-4869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty