# STATELINE FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578012936
- **Authorized official:** MR. DOUG BRITT (CEO/EXECUTIVE DIRECTOR)
- **Authorized official phone:** (608) 365-2261

## Contact information

- **Practice address:** 1865 RIVERSIDE DR, BELOIT, WI 53511-3521
- **Practice address phone:** (608) 365-2261
- **Practice address fax:** (608) 365-7091
- **Mailing address:** 1865 RIVERSIDE DR, BELOIT, WI 53511-3521
- **Mailing address phone:** (608) 365-2261
- **Mailing address fax:** (608) 365-7091

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174H00000X | Health Educator | — | NULL | Yes |
| 174H00000X | Health Educator | — | — | Yes |

## Other

- **Enumeration date:** 09/27/2016
- **Last updated:** 09/27/2016