=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346338928
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TELECARE CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2006
-----------------------------------------------------
Last Update Date | 03/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18949 REDWOOD RD
-----------------------------------------------------
City | CASTRO VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94546-3153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-881-1606
-----------------------------------------------------
Fax | 510-881-1506
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1080 MARINA VILLAGE PKWY STE 100
-----------------------------------------------------
City | ALAMEDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94501-1078
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-337-7950
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER RELATIONS SUPERVISOR
-----------------------------------------------------
Name | LORENA LOPEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 510-337-7950
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320800000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
-----------------------------------------------------
License Number | DMH 02 037 024
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------