Provider Demographics
NPI:1346797321
Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF MEMPHIS & THE MID-SOUTH
Entity type:Organization
Organization Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF MEMPHIS & THE MID-SOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-766-7677
Mailing Address - Street 1:6373 N QUAIL HOLLOW RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-1405
Mailing Address - Country:US
Mailing Address - Phone:901-766-7677
Mailing Address - Fax:901-766-7687
Practice Address - Street 1:245 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2731
Practice Address - Country:US
Practice Address - Phone:901-527-9622
Practice Address - Fax:901-527-9638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty