Organization
YMCA OF GREATER MONMOUTH COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEEANN WAGNER (VICE PRESIDENT)
(732) 290-9040
Entity
Organization
Contact information
Practice address
202 MAIN ST, PORT MONMOUTH, NJ 07758-1252
(732) 290-9040
(732) 566-0433
Mailing address
166 MAIN ST, MATAWAN, NJ 07747-3104
(732) 290-9040
(732) 566-0433
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
100052505
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0411299
—
NJ
Enumeration date
02/07/2017
Last updated
08/11/2020
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