Provider Demographics
NPI:1790450575
Name:IDAHO FALLS FAMILY YMCA
Entity Type:Organization
Organization Name:IDAHO FALLS FAMILY YMCA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FITNESS & MEMBERSHIP DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-523-0600
Mailing Address - Street 1:155 N CORNER ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-4013
Mailing Address - Country:US
Mailing Address - Phone:208-523-0600
Mailing Address - Fax:
Practice Address - Street 1:155 N CORNER ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-4013
Practice Address - Country:US
Practice Address - Phone:208-523-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare