Provider Demographics
NPI:1902353899
Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF BOULDER VALLEY
Entity Type:Organization
Organization Name:YOUNG MEN'S CHRISTIAN ASSOCIATION OF BOULDER VALLEY
Other - Org Name:YMCA OF BOULDER VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-443-4474
Mailing Address - Street 1:2800 DAGNY WAY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-8011
Mailing Address - Country:US
Mailing Address - Phone:303-443-4474
Mailing Address - Fax:303-664-5459
Practice Address - Street 1:2850 MAPLETON AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1122
Practice Address - Country:US
Practice Address - Phone:303-442-2778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty