Provider Demographics
NPI:1528503711
Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF GRANTS PASS, OREGON
Entity type:Organization
Organization Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF GRANTS PASS, OREGON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-474-0001
Mailing Address - Street 1:1000 REDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5586
Mailing Address - Country:US
Mailing Address - Phone:541-474-0001
Mailing Address - Fax:541-474-0087
Practice Address - Street 1:1550 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5531
Practice Address - Country:US
Practice Address - Phone:541-479-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-27
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty