Healthcare Provider Details

I. General information

NPI: 1487003471
Provider Name (Legal Business Name): TELECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 06/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 CARMEN LN
SANTA MARIA CA
93458-7768
US

IV. Provider business mailing address

124 CARMEN LN
SANTA MARIA CA
93458-7768
US

V. Phone/Fax

Practice location:
  • Phone: 805-348-1850
  • Fax: 805-348-1857
Mailing address:
  • Phone: 805-348-1850
  • Fax: 805-348-1857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number941735271
License Number StateCA

VIII. Authorized Official

Name: MRS. MARIE MICHELE CHISUM
Title or Position: AA/HR
Credential:
Phone: 805-348-1850