Healthcare Provider Details

I. General information

NPI: 1740378371
Provider Name (Legal Business Name): TELECARE MENTAL HEALTH SERVICES OF OREGON, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4104 NE DIVISION ST
GRESHAM OR
97030-4618
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 503-666-6575
  • Fax: 503-666-4047
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: LORENA LOPEZ
Title or Position: PROVIDER RELATIONS SUPERVISOR
Credential:
Phone: 510-337-7950