Provider Demographics
NPI:1609218593
Name:YOUNG MENS CHRISTIAN ASSOCIATION OF GREATER ST LOUIS
Entity Type:Organization
Organization Name:YOUNG MENS CHRISTIAN ASSOCIATION OF GREATER ST LOUIS
Other - Org Name:YMCA
Other - Org Type:Other Name
Authorized Official - Title/Position:SENIOR PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDMOND
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:314-352-5087
Mailing Address - Street 1:7023 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63111-3119
Mailing Address - Country:US
Mailing Address - Phone:314-352-5087
Mailing Address - Fax:314-353-0439
Practice Address - Street 1:1528 LOCUST ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-1816
Practice Address - Country:US
Practice Address - Phone:314-436-1177
Practice Address - Fax:314-436-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOEL1-0043-0313320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities