Provider Demographics
NPI:1164972360
Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF GREATER LONG BEACH
Entity Type:Organization
Organization Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF GREATER LONG BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:VELASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-279-1738
Mailing Address - Street 1:3605 LONG BEACH BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807
Mailing Address - Country:US
Mailing Address - Phone:562-279-1700
Mailing Address - Fax:562-279-1705
Practice Address - Street 1:4949 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805
Practice Address - Country:US
Practice Address - Phone:562-423-0491
Practice Address - Fax:562-984-9611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty