Provider Demographics
NPI:1528515376
Name:THE YOUNG MEN'S CHRISTIAN ASSOCIATION OF GREATER GRAND RAPIDS
Entity type:Organization
Organization Name:THE YOUNG MEN'S CHRISTIAN ASSOCIATION OF GREATER GRAND RAPIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-855-9602
Mailing Address - Street 1:475 LAKE MICHIGAN DR NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-5600
Mailing Address - Country:US
Mailing Address - Phone:616-855-9671
Mailing Address - Fax:
Practice Address - Street 1:475 LAKE MICHIGAN DR NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-5600
Practice Address - Country:US
Practice Address - Phone:616-855-9671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty