Provider Demographics
NPI:1770032419
Name:LA CROSSE AREA FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.
Entity Type:Organization
Organization Name:LA CROSSE AREA FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:SOPER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:608-782-5944
Mailing Address - Street 1:1140 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601
Mailing Address - Country:US
Mailing Address - Phone:608-782-9622
Mailing Address - Fax:608-782-9616
Practice Address - Street 1:1140 MAIN STREET
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601
Practice Address - Country:US
Practice Address - Phone:608-782-9622
Practice Address - Fax:608-782-9616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty