1154878619 NPI number — REGIONAL YOUNG MEN'S CHRISTIAN ASSOCIATION OF WESTERN CONNECTICUT, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154878619 NPI number — REGIONAL YOUNG MEN'S CHRISTIAN ASSOCIATION OF WESTERN CONNECTICUT, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGIONAL YOUNG MEN'S CHRISTIAN ASSOCIATION OF WESTERN CONNECTICUT, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154878619
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
241 FEDERAL ROAD
Provider Second Line Business Mailing Address:
UNIT B21
Provider Business Mailing Address City Name:
BROOKFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-740-3432
Provider Business Mailing Address Fax Number:
203-775-8350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
241 FEDERAL ROAD
Provider Second Line Business Practice Location Address:
UNIT B21
Provider Business Practice Location Address City Name:
BROOKFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-740-3432
Provider Business Practice Location Address Fax Number:
203-775-8350
Provider Enumeration Date:
09/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MISZEWSKI
Authorized Official First Name:
MARIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
203-740-3432

Provider Taxonomy Codes

  • Taxonomy code: 174H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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