Provider Demographics
NPI:1295860146
Name:FAMILY SERVICE AGENCY, INC
Entity Type:Organization
Organization Name:FAMILY SERVICE AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WALLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-587-7880
Mailing Address - Street 1:3347 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2299
Mailing Address - Country:US
Mailing Address - Phone:954-587-7880
Mailing Address - Fax:954-587-3229
Practice Address - Street 1:3347 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-2299
Practice Address - Country:US
Practice Address - Phone:954-587-7880
Practice Address - Fax:954-587-3229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0169AMedicare ID - Type UnspecifiedPROVIDER #