Healthcare Provider Details

I. General information

NPI: 1780131557
Provider Name (Legal Business Name): GATEWAY REGION YOUNG MEN'S CHRISTIAN ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 SCOTT AVE STE D
SAINT LOUIS MO
63103-3009
US

IV. Provider business mailing address

2815 SCOTT AVE STE D
SAINT LOUIS MO
63103-3009
US

V. Phone/Fax

Practice location:
  • Phone: 314-788-2047
  • Fax:
Mailing address:
  • Phone: 314-788-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TIM HELM
Title or Position: PRESIDENT/CEO
Credential:
Phone: 314-436-1177