MEDICARE: THE YOUNG MEN'S CHRISTIAN ASSOCIATION OF NORTHERN UTAH

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

General Provider Information

NPI Number	:	1932657210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE YOUNG MEN'S CHRISTIAN ASSOCIATION OF NORTHERN UTAH

Provider Business Mailing Address
First Line	:	3216 S HIGHLAND DR
Second Line	:	SUITE 200
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-4178
Country	:	US
Telephone Number	:	801-466-6074
Fax Number	:	801-466-6074

Provider Business Practice Location Address
First Line	:	3216 S HIGHLAND DR
Second Line	:	SUITE 200
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-4178
Country	:	US
Telephone Number	:	801-466-6074
Fax Number	:	801-466-6074

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	RICH WEST
Credential	:
Telephone Number	:	801-839-3384

Provider Enumeration Date	:	09/15/2016
Last Update Date	:	10/11/2016

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