Provider Demographics
NPI:1659820215
Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF AUSTIN, MINNESOTA
Entity Type:Organization
Organization Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF AUSTIN, MINNESOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TEDD
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-433-1804
Mailing Address - Street 1:704 1ST DR NW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-3004
Mailing Address - Country:US
Mailing Address - Phone:507-433-1804
Mailing Address - Fax:507-433-1806
Practice Address - Street 1:704 1ST DR NW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-3004
Practice Address - Country:US
Practice Address - Phone:507-433-1804
Practice Address - Fax:507-433-1806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty