Healthcare Provider Details

I. General information

NPI: 1205480563
Provider Name (Legal Business Name): TELECARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 AGNES AVE
SANTA MARIA CA
93458-2838
US

IV. Provider business mailing address

1080 MARINA VILLAGE PKWY STE 100
ALAMEDA CA
94501-1078
US

V. Phone/Fax

Practice location:
  • Phone: 805-457-3724
  • Fax: 805-852-1863
Mailing address:
  • Phone: 510-337-7950
  • Fax: 510-337-7969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: LESLIE DAVIS
Title or Position: SVP, CFO
Credential:
Phone: 510-337-7950