1932659703 NPI number — YOUNG MENS CHRISTIAN ASSOCIATION OF CENTRAL STARK COUNTY, 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 1932659703 NPI number — YOUNG MENS CHRISTIAN ASSOCIATION OF CENTRAL STARK COUNTY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOUNG MENS CHRISTIAN ASSOCIATION OF CENTRAL STARK COUNTY, 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:
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:
1932659703
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 30TH ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44709-2959
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-491-9622
Provider Business Mailing Address Fax Number:
330-491-8157

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7389 CARITAS CIR NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MASSILLON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44646-9118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-830-6275
Provider Business Practice Location Address Fax Number:
330-837-9587
Provider Enumeration Date:
10/05/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SHETZER
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
330-491-9622

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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