Provider Demographics
NPI:1508523770
Name:UHO - YMCA OF METROPOLITAN MILWAUKEE
Entity Type:Organization
Organization Name:UHO - YMCA OF METROPOLITAN MILWAUKEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOMBS-GEROU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-274-0708
Mailing Address - Street 1:345 W SAINT PAUL AVE STE 2174
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203-3099
Mailing Address - Country:US
Mailing Address - Phone:414-274-0708
Mailing Address - Fax:
Practice Address - Street 1:7095 S BALLPARK DR STE 120
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-6908
Practice Address - Country:US
Practice Address - Phone:414-224-9622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty