Provider Demographics
NPI:1245393503
Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF THE EAST BAY
Entity Type:Organization
Organization Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF THE EAST BAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:LAU
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:510-318-7654
Mailing Address - Street 1:2330 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2415
Mailing Address - Country:US
Mailing Address - Phone:510-451-9622
Mailing Address - Fax:
Practice Address - Street 1:3260 BLUME DR
Practice Address - Street 2:SUITE 450
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-5203
Practice Address - Country:US
Practice Address - Phone:510-262-6551
Practice Address - Fax:510-222-7085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
CAMFC27191251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or CharitableGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty