Healthcare Provider Details

I. General information

NPI: 1841504768
Provider Name (Legal Business Name): TELECARE MENTAL HEALTH SERVICES OF WASHINGTON, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E FOURTH PLAIN BLVD BUILDING 17
VANCOUVER WA
98661-3753
US

IV. Provider business mailing address

1080 MARINA VILLAGE PKWY SUITE 100
ALAMEDA CA
94501-6427
US

V. Phone/Fax

Practice location:
  • Phone: 360-397-8474
  • Fax: 360-397-8481
Mailing address:
  • Phone: 510-337-7950
  • Fax: 510-337-7969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARSHALL LANGFELD
Title or Position: SVP, CFO
Credential:
Phone: 360-397-8474