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General NPI Number Information
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NPI Number | 1194813717
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Entity Type | Organization
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Legal Business Name | TELCARE CORPORATION
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 03/14/2018
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Provider Practice Location Address
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Address Line | 101 CIRBY HILLS DR STE 4
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City | ROSEVILLE
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State | CA
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Zip | 95678-4360
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Country | US
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Telephone | 916-787-8900
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Fax | 916-787-8919
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Provider Business Mailing Address
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Address Line | 1080 MARINA VILLAGE PKWY STE 100
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City | ALAMEDA
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State | CA
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Zip | 94501-1078
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Country | US
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Telephone | 510-337-7950
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Fax |
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Authorized Official
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Title or Position | SVP, CFO
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Name | LESLIE DAVIS
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Credential |
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Telephone | 510-337-7950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | DMH 02016033
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License Number State | CA
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