Provider Demographics
NPI:1508246430
Name:STANISLAUS PHF
Entity Type:Organization
Organization Name:STANISLAUS PHF
Other - Org Name:TELECARE CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LVN
Authorized Official - Prefix:MISS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:LENAURA
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:209-568-2266
Mailing Address - Street 1:436 N MERCEY SPRINGS RD SPC 13
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-3031
Mailing Address - Country:US
Mailing Address - Phone:209-568-2266
Mailing Address - Fax:
Practice Address - Street 1:436 N MERCEY SPRINGS RD SPC 13
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-3031
Practice Address - Country:US
Practice Address - Phone:209-568-2266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN220172323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility