Provider Demographics
NPI:1598587149
Name:OLD COLONY YMCA WELLNESS SERVICES, INC.
Entity type:Organization
Organization Name:OLD COLONY YMCA WELLNESS SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:CLIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-897-1220
Mailing Address - Street 1:320 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5340
Mailing Address - Country:US
Mailing Address - Phone:781-341-2016
Mailing Address - Fax:
Practice Address - Street 1:445 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-1900
Practice Address - Country:US
Practice Address - Phone:781-341-2016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLD COLONY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management