MEDICARE: YOUNG MEN'S CHRISTIAN ASSOCIATION OF THE EAST BAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator
2	251V00000X	Voluntary or Charitable Agency	MFC27191	CA

General Provider Information

NPI Number	:	1245393503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNG MEN'S CHRISTIAN ASSOCIATION OF THE EAST BAY

Provider Business Mailing Address
First Line	:	2330 BROADWAY
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94612-2415
Country	:	US
Telephone Number	:	510-451-9622
Fax Number	:

Provider Business Practice Location Address
First Line	:	3260 BLUME DR
Second Line	:	SUITE 450
City	:	RICHMOND
State	:	CA
Zip	:	94806-5203
Country	:	US
Telephone Number	:	510-262-6551
Fax Number	:	510-222-7085

Authorized Official
Title or Position	:	INTERIM PRESIDENT AND CEO
Name	:	MR. DON LAU
Credential	:	M.A.
Telephone Number	:	510-318-7654

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	02/15/2017

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