Provider Demographics
NPI:1336684695
Name:TWO RIVERS YOUNG MEN'S CHRISTIAN ASSOCIATION INC.
Entity type:Organization
Organization Name:TWO RIVERS YOUNG MEN'S CHRISTIAN ASSOCIATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WENNEKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-797-3945
Mailing Address - Street 1:2040 53RD ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-3650
Mailing Address - Country:US
Mailing Address - Phone:309-797-3945
Mailing Address - Fax:309-277-1792
Practice Address - Street 1:2040 53RD ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-3650
Practice Address - Country:US
Practice Address - Phone:309-797-3945
Practice Address - Fax:309-277-1792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty