Healthcare Provider Details

I. General information

NPI: 1952857328
Provider Name (Legal Business Name): THE YOUNG MEN'S CHRISTIAN ASSOCIATION OF THE PIKES PEAK REGION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N NEVADA AVE
COLORADO SPRINGS CO
80903-1306
US

IV. Provider business mailing address

316 N TEJON ST
COLORADO SPRINGS CO
80903-1224
US

V. Phone/Fax

Practice location:
  • Phone: 719-473-9622
  • Fax: 719-471-1723
Mailing address:
  • Phone: 719-471-9790
  • Fax: 719-578-0185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BOYD WILLIAMS
Title or Position: CEO
Credential:
Phone: 719-471-9790