Healthcare Provider Details

I. General information

NPI: 1659758639
Provider Name (Legal Business Name): TELECARE MENTAL HEALTH SERVICES OF WASHINGTON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 STATE ROUTE 20
SEDRO WOOLLEY WA
98284-4322
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 360-854-7400
  • Fax: 360-854-7446
Mailing address:
  • Phone: 510-337-7950
  • Fax: 510-337-7969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
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