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NPI Code Detail

MEDICARE: TELECARE MENTAL HEALTH SERVICES OF WASHINGTON, INC

MEDICARE: TELECARE MENTAL HEALTH SERVICES OF WASHINGTON, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1323P00000XPsychiatric Residential Treatment Facility
2320800000XMental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1275178360
Entity Type Code : Organization
Provider Name (Legal Business Name) : TELECARE MENTAL HEALTH SERVICES OF WASHINGTON, INC
Provider Business Mailing Address
First Line : 1080 MARINA VILLAGE PKWY STE 100
Second Line :
City : ALAMEDA
State : CA
Zip : 94501-1078
Country : US
Telephone Number : 510-337-7950
Fax Number : 510-337-7969
Provider Business Practice Location Address
First Line : 307 W COTA ST
Second Line :
City : SHELTON
State : WA
Zip : 98584-2265
Country : US
Telephone Number : 510-337-7950
Fax Number :
Authorized Official
Title or Position : SVP, CFO
Name : LESLIE DAVIS
Credential :
Telephone Number : 510-337-7950
Provider Enumeration Date : 11/12/2019
Last Update Date : 12/14/2021

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