Provider Demographics
NPI:1629248521
Name:TELAMON CORPORATION
Entity Type:Organization
Organization Name:TELAMON CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:CROOKE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:919-239-8115
Mailing Address - Street 1:3937 WESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-1936
Mailing Address - Country:US
Mailing Address - Phone:919-239-8115
Mailing Address - Fax:919-851-1139
Practice Address - Street 1:60 W SIOUX LN
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-1431
Practice Address - Country:US
Practice Address - Phone:304-822-4514
Practice Address - Fax:304-822-4515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001509Medicaid