Provider Demographics
NPI:1588111496
Name:LIGONIER VALLEY YOUNG MEN'S CHRISTIAN ASSOCIATION OF PENNSYLVANIA, INC
Entity type:Organization
Organization Name:LIGONIER VALLEY YOUNG MEN'S CHRISTIAN ASSOCIATION OF PENNSYLVANIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:STORMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-238-7580
Mailing Address - Street 1:110 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-1223
Mailing Address - Country:US
Mailing Address - Phone:724-238-7580
Mailing Address - Fax:724-238-3619
Practice Address - Street 1:110 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-1223
Practice Address - Country:US
Practice Address - Phone:724-238-7580
Practice Address - Fax:724-238-3619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty