1891244257 NPI number — YOUNG MEN'S CHRISTIAN ASSOCIATION OF GREATER EL PASO TX AND RIO GRANDE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891244257 NPI number — YOUNG MEN'S CHRISTIAN ASSOCIATION OF GREATER EL PASO TX AND RIO GRANDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOUNG MEN'S CHRISTIAN ASSOCIATION OF GREATER EL PASO TX AND RIO GRANDE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891244257
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
810 WYOMING AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79902-5339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-532-9622
Provider Business Mailing Address Fax Number:
915-544-8729

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5509 WILL RUTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79924-5433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-755-9622
Provider Business Practice Location Address Fax Number:
915-751-0533
Provider Enumeration Date:
09/27/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COON
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
LOYD
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
915-532-9622

Provider Taxonomy Codes

  • Taxonomy code: 174H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)