Provider Demographics
NPI:1770028771
Name:KANDIYOHI COUNTY AREA FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION
Entity type:Organization
Organization Name:KANDIYOHI COUNTY AREA FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-222-9622
Mailing Address - Street 1:1000 LAKELAND DR SE
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-4708
Mailing Address - Country:US
Mailing Address - Phone:320-222-9622
Mailing Address - Fax:320-222-7197
Practice Address - Street 1:1000 LAKELAND DR SE
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-4708
Practice Address - Country:US
Practice Address - Phone:320-222-9622
Practice Address - Fax:320-222-7197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty