Healthcare Provider Details

I. General information

NPI: 1891244257
Provider Name (Legal Business Name): YOUNG MEN'S CHRISTIAN ASSOCIATION OF GREATER EL PASO TX AND RIO GRANDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5509 WILL RUTH AVE
EL PASO TX
79924-5433
US

IV. Provider business mailing address

810 WYOMING AVE
EL PASO TX
79902-5339
US

V. Phone/Fax

Practice location:
  • Phone: 915-755-9622
  • Fax: 915-751-0533
Mailing address:
  • Phone: 915-532-9622
  • Fax: 915-544-8729

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. WILLIAM LOYD COON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 915-532-9622