Provider Demographics
NPI:1811688302
Name:YMCA OF SUPERIOR CALIFORNIA
Entity type:Organization
Organization Name:YMCA OF SUPERIOR CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF DEVELOPMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH-FAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-231-0362
Mailing Address - Street 1:1926 V ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-1624
Mailing Address - Country:US
Mailing Address - Phone:916-529-9886
Mailing Address - Fax:
Practice Address - Street 1:2021 W ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-1625
Practice Address - Country:US
Practice Address - Phone:916-452-9622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No332U00000XSuppliersHome Delivered MealsGroup - Multi-Specialty