Provider Demographics
NPI:1023565934
Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF SOUTHERN ARIZONA
Entity type:Organization
Organization Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF SOUTHERN ARIZONA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANE
Authorized Official - Middle Name:G
Authorized Official - Last Name:WOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-623-5511
Mailing Address - Street 1:PO BOX 1111
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85702-1111
Mailing Address - Country:US
Mailing Address - Phone:520-623-5511
Mailing Address - Fax:520-624-1518
Practice Address - Street 1:60 W ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85701-1307
Practice Address - Country:US
Practice Address - Phone:520-623-5511
Practice Address - Fax:520-624-1518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty