Provider Demographics
NPI:1144662289
Name:PENINSULA FAMILY YMCA
Entity type:Organization
Organization Name:PENINSULA FAMILY YMCA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH AND WELLNESS
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:650-294-2614
Mailing Address - Street 1:1877 S GRANT ST
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2647
Mailing Address - Country:US
Mailing Address - Phone:650-294-2614
Mailing Address - Fax:
Practice Address - Street 1:1877 S GRANT ST
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2647
Practice Address - Country:US
Practice Address - Phone:650-294-2614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YMCA OF SAN FRANCISCO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty