Healthcare Provider Details

I. General information

NPI: 1790298347
Provider Name (Legal Business Name): TELECARE MENTAL HEALTH SERVICES OF WASHINGTON, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33480 13TH PL S
FEDERAL WAY WA
98003-6357
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 253-285-7101
  • Fax: 253-874-7096
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