Healthcare Provider Details

I. General information

NPI: 1285739318
Provider Name (Legal Business Name): FAMILY SERVICE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21250 BOX SPRINGS ROAD SUITE 106
MORENO VALLEY CA
92557-8705
US

IV. Provider business mailing address

21250 BOX SPRINGS ROAD SUITE 106
MORENO VALLEY CA
92557-8705
US

V. Phone/Fax

Practice location:
  • Phone: 951-369-8036
  • Fax: 951-369-8303
Mailing address:
  • Phone: 951-369-8036
  • Fax: 951-369-8303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: SHANNON GONZALEZ
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 951-686-1096