Provider Demographics
NPI:1326595356
Name:THE YOUNG MEN'S CHRISTIAN ASSOCIATION OF WALLA WALLA
Entity Type:Organization
Organization Name:THE YOUNG MEN'S CHRISTIAN ASSOCIATION OF WALLA WALLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTINAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-525-8863
Mailing Address - Street 1:340 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3249
Mailing Address - Country:US
Mailing Address - Phone:509-525-8863
Mailing Address - Fax:
Practice Address - Street 1:340 S PARK ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3249
Practice Address - Country:US
Practice Address - Phone:509-525-8863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty