Provider Demographics
NPI:1861943342
Name:THE KISHWAUKEE FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.
Entity type:Organization
Organization Name:THE KISHWAUKEE FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEIGELHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-756-9577
Mailing Address - Street 1:2500 BETHANY RD
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3129
Mailing Address - Country:US
Mailing Address - Phone:815-756-9577
Mailing Address - Fax:815-758-4549
Practice Address - Street 1:2500 BETHANY RD
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3129
Practice Address - Country:US
Practice Address - Phone:815-756-9577
Practice Address - Fax:815-758-4549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty