Provider Demographics
NPI:1043851686
Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF GRAND FORKS
Entity type:Organization
Organization Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF GRAND FORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTHY LIVING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SORUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-775-2586
Mailing Address - Street 1:215 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-3668
Mailing Address - Country:US
Mailing Address - Phone:701-775-2586
Mailing Address - Fax:701-775-9611
Practice Address - Street 1:215 N 7TH ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203-3668
Practice Address - Country:US
Practice Address - Phone:701-775-2586
Practice Address - Fax:701-775-9611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-04
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty