1598587149 NPI number — OLD COLONY YMCA WELLNESS SERVICES, 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 1598587149 NPI number — OLD COLONY YMCA WELLNESS SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLD COLONY YMCA WELLNESS SERVICES, 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:
1598587149
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROCKTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02301-5340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-341-2016
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
445 CENTRAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STOUGHTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02072-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-341-2016
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/25/2024

Additional Information

Authorized Official

Authorized Official Last Name:
CLIFFORD
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
508-897-1220

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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