Healthcare Provider Details

I. General information

NPI: 1114788239
Provider Name (Legal Business Name): FAMILIES TOGETHER OF ORANGE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 W 1ST ST
TUSTIN CA
92780-2939
US

IV. Provider business mailing address

661 W 1ST ST STE G
TUSTIN CA
92780-2939
US

V. Phone/Fax

Practice location:
  • Phone: 714-665-9890
  • Fax: 714-665-9891
Mailing address:
  • Phone: 714-665-9890
  • Fax: 714-665-9891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER ROSSEL
Title or Position: CEO
Credential:
Phone: 714-665-9890