Provider Demographics
NPI:1528595360
Name:TELECARE
Entity Type:Organization
Organization Name:TELECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSC
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-382-9902
Mailing Address - Street 1:776 FLORENCE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92132-0001
Mailing Address - Country:US
Mailing Address - Phone:619-382-9902
Mailing Address - Fax:
Practice Address - Street 1:776 FLORENCE ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92132-0001
Practice Address - Country:US
Practice Address - Phone:619-382-9902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare