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General NPI Number Information
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NPI Number | 1558635672
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Entity Type | Organization
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Legal Business Name | TELECARE CORPORATION
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Dates
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Enumeration Date | 03/07/2012
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Last Update Date | 03/07/2012
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Provider Practice Location Address
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Address Line | 20370 POE SHOLES DR.
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City | BEND
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State | OR
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Zip | 97701
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Country | US
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Telephone | 541-318-1377
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Fax |
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Provider Business Mailing Address
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Address Line | 20370 POE SHOLES DR
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City | BEND
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State | OR
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Zip | 97701-7938
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Country | US
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Telephone | 541-318-1377
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Fax |
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Authorized Official
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Title or Position | RECOVERY SPECIALIST/REGISTERED NURS
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Name | CHRISTINE DENISE RILEY
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Credential | RN
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Telephone | 541-318-1377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310500000X
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Taxonomy Name | Mental Illness Intermediate Care Facility
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License Number | 200942082RN
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License Number State | OR
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