Provider Demographics
NPI:1477751188
Name:TELECARE CORPORATION GLADMAN MENTAL HEALTH REHABILITATION CENTER
Entity Type:Organization
Organization Name:TELECARE CORPORATION GLADMAN MENTAL HEALTH REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER RELATIONS SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-337-7950
Mailing Address - Street 1:2633 E 27TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-1912
Mailing Address - Country:US
Mailing Address - Phone:510-536-8111
Mailing Address - Fax:510-534-5202
Practice Address - Street 1:2633 E 27TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-1912
Practice Address - Country:US
Practice Address - Phone:510-536-8111
Practice Address - Fax:510-534-5202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA02080009323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility