Healthcare Provider Details

I. General information

NPI: 1477751188
Provider Name (Legal Business Name): TELECARE CORPORATION GLADMAN MENTAL HEALTH REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 E 27TH ST
OAKLAND CA
94601-1912
US

IV. Provider business mailing address

2633 E 27TH ST
OAKLAND CA
94601-1912
US

V. Phone/Fax

Practice location:
  • Phone: 510-536-8111
  • Fax: 510-534-5202
Mailing address:
  • Phone: 510-536-8111
  • Fax: 510-534-5202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number02080009
License Number StateCA

VIII. Authorized Official

Name: LORENA LOPEZ
Title or Position: PROVIDER RELATIONS SUPERVISOR
Credential:
Phone: 510-337-7950