Healthcare Provider Details

I. General information

NPI: 1942737648
Provider Name (Legal Business Name): TELECARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25402 PACIFICA AVE
MISSION VIEJO CA
92691-3854
US

IV. Provider business mailing address

1080 MARINA VILLAGE PARKWAY SUITE 100
ALAMEDA CA
94501-1078
US

V. Phone/Fax

Practice location:
  • Phone: 949-238-2400
  • Fax:
Mailing address:
  • Phone: 510-337-7950
  • Fax: 510-337-7969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: LORENA LOPEZ
Title or Position: PROVIDER RELATIONS SUPERVISOR
Credential:
Phone: 510-747-0552