Healthcare Provider Details

I. General information

NPI: 1659822047
Provider Name (Legal Business Name): YOUNG MEN'S CHRISTIAN ASSOCIATION OF PIERCE AND KITSAP COUNTIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4717 S 19TH ST #201
TACOMA WA
98405-1167
US

IV. Provider business mailing address

4717 S 19TH ST #201
TACOMA WA
98405-1167
US

V. Phone/Fax

Practice location:
  • Phone: 253-534-7800
  • Fax: 253-566-9657
Mailing address:
  • Phone: 253-534-7800
  • Fax: 253-566-9657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANNE PORTER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 253-534-7812