Provider Demographics
NPI:1891240131
Name:FAMILY SERVICE AGENCY OF THE CENTRAL COAST
Entity Type:Organization
Organization Name:FAMILY SERVICE AGENCY OF THE CENTRAL COAST
Other - Org Name:FAMILY SERVICE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:BIANCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-423-9444
Mailing Address - Street 1:2901 PARK AVE
Mailing Address - Street 2:SUITE A3
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2831
Mailing Address - Country:US
Mailing Address - Phone:831-346-6767
Mailing Address - Fax:831-346-6771
Practice Address - Street 1:2901 PARK AVE
Practice Address - Street 2:SUITE A3
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2831
Practice Address - Country:US
Practice Address - Phone:831-346-6767
Practice Address - Fax:831-346-6771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health