Provider Demographics
NPI:1902898141
Name:THE YOUNG MEN'S CHRISTIAN ASSOCIATION OF RED BANK, NJ A NONPROFIT CORP
Entity Type:Organization
Organization Name:THE YOUNG MEN'S CHRISTIAN ASSOCIATION OF RED BANK, NJ A NONPROFIT CORP
Other - Org Name:THE COMMUNITY YMCA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-784-6612
Mailing Address - Street 1:170 PATTERSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702
Mailing Address - Country:US
Mailing Address - Phone:732-671-5505
Mailing Address - Fax:732-784-6609
Practice Address - Street 1:166 MAPLE AVENUE
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701
Practice Address - Country:US
Practice Address - Phone:732-741-2504
Practice Address - Fax:743-842-3396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0035807Medicaid
NJ0020567Medicaid
NJ0020567Medicaid