1760549125 NPI number — FAMILY SERVICE ASSOCIATION

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 1760549125 NPI number — FAMILY SERVICE ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY SERVICE ASSOCIATION
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:
1760549125
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/30/2012
NPI Reactivation Date:
11/09/2012

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21250 BOX SPRINGS ROAD
Provider Second Line Business Mailing Address:
SUITE 212
Provider Business Mailing Address City Name:
MORENO VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92557-8705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-686-1096
Provider Business Mailing Address Fax Number:
951-686-5382

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21250 BOX SPRINGS ROAD
Provider Second Line Business Practice Location Address:
SUITE 105, 106, 201, 202, 203, 205, 206, 212
Provider Business Practice Location Address City Name:
MORENO VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92557-8705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-686-3706
Provider Business Practice Location Address Fax Number:
951-686-7267
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DOVER
Authorized Official First Name:
VERONICA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
951-686-1096

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com