Healthcare Provider Details

I. General information

NPI: 1043768476
Provider Name (Legal Business Name): VALLEY OF THE SUN YOUNG MEN'S CHRISTIAN ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N 1ST AVE
PHOENIX AZ
85003-1513
US

IV. Provider business mailing address

350 N 1ST AVE
PHOENIX AZ
85003-1513
US

V. Phone/Fax

Practice location:
  • Phone: 602-257-5120
  • Fax: 602-257-5136
Mailing address:
  • Phone: 602-257-5120
  • Fax: 602-257-5136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: MR. BRYAN MADDEN
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 602-257-5133