Provider Demographics
NPI:1700333721
Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF ROANOKE VALLEY, INC.
Entity Type:Organization
Organization Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF ROANOKE VALLEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-527-9622
Mailing Address - Street 1:PO BOX 2130
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24009-2130
Mailing Address - Country:US
Mailing Address - Phone:540-342-9622
Mailing Address - Fax:540-345-0730
Practice Address - Street 1:1126 KIME LN
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-5301
Practice Address - Country:US
Practice Address - Phone:540-387-9622
Practice Address - Fax:540-389-7152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty