Provider Demographics
NPI:1700321734
Name:THE YOUNG MEN'S CHRISTIAN ASSOCIATION OF RACINE, WISCONSIN
Entity Type:Organization
Organization Name:THE YOUNG MEN'S CHRISTIAN ASSOCIATION OF RACINE, WISCONSIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-634-1994
Mailing Address - Street 1:725 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-1207
Mailing Address - Country:US
Mailing Address - Phone:262-634-1994
Mailing Address - Fax:262-634-0401
Practice Address - Street 1:725 LAKE AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-1207
Practice Address - Country:US
Practice Address - Phone:262-634-1994
Practice Address - Fax:262-634-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty