1700064193 NPI number — TELECARE CORPORATION

Table of content: (NPI 1700064193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700064193 NPI number — TELECARE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TELECARE CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TELECARE TRANSITIONAL AGE YOUTH BEHAVIORAL HEALTH SERVICE TEAM
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700064193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1080 MARINA VILLAGE PKWY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
ALAMEDA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94501-6427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-337-7950
Provider Business Mailing Address Fax Number:
510-337-7969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 DOWNEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MODESTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95354-1208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-558-4773
Provider Business Practice Location Address Fax Number:
209-558-4450
Provider Enumeration Date:
02/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP, CFO
Authorized Official Telephone Number:
510-337-7950

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 50BF . This is a "COUNTY MENTAL HEALTH CERTIFICATE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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