| Family Service Association | |
|
2211 Arbor Blvd Moraine OH 45439-1521 | |
| (937) 222-9481 | |
| (937) 222-3710 |
| Full Name | Family Service Association |
|---|---|
| Speciality | Clinic/Center |
| Location | 2211 Arbor Blvd, Moraine, Ohio |
| Authorized Official Name and Position | Bonnie R. Parish (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9372229481 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Service Association 2211 Arbor Blvd Moraine OH 45439-1521 Ph: (937) 222-9481 | Family Service Association 2211 Arbor Blvd Moraine OH 45439-1521 Ph: (937) 222-9481 |
| NPI Number | 1063442390 |
|---|---|
| Provider Enumeration Date | 07/03/2006 |
| Last Update Date | 06/26/2025 |
| Certification Date | 06/26/2025 |
| Medicare PECOS PAC ID | 7618948423 |
|---|---|
| Medicare Enrollment ID | O20040804001481 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063442390 | NPI | - | NPPES |
| MC34-16 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Polly S Vaughan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063609287 PECOS PAC ID: 3375625320 Enrollment ID: I20080129000682 |
| Provider Name | Bonnie R Parish |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003100207 PECOS PAC ID: 6103897848 Enrollment ID: I20110808000714 |
| Provider Name | Joanna White |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649796004 PECOS PAC ID: 4486901634 Enrollment ID: I20180719002199 |
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