Provider Demographics
NPI:1114476033
Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF ALBERT LEA, MINNESOTA, INC.
Entity Type:Organization
Organization Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF ALBERT LEA, MINNESOTA, INC.
Other - Org Name:ALBERT LEA FAMILY Y
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DIESER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-373-8228
Mailing Address - Street 1:2021 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007-4335
Mailing Address - Country:US
Mailing Address - Phone:507-373-8228
Mailing Address - Fax:507-373-1053
Practice Address - Street 1:404 W FOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-2437
Practice Address - Country:US
Practice Address - Phone:507-373-2384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty