Provider Demographics
NPI:1588111512
Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF FOND DU LAC, WISCONSIN, INC.
Entity type:Organization
Organization Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF FOND DU LAC, WISCONSIN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:GILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-921-3330
Mailing Address - Street 1:90 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4141
Mailing Address - Country:US
Mailing Address - Phone:920-921-3330
Mailing Address - Fax:920-921-3376
Practice Address - Street 1:90 W 2ND ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4141
Practice Address - Country:US
Practice Address - Phone:920-921-3330
Practice Address - Fax:920-921-3376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty