Provider Demographics
NPI:1770727208
Name:TELECARE LOS ANGELES ADULT SERVICES
Entity type:Organization
Organization Name:TELECARE LOS ANGELES ADULT SERVICES
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 1:1080 MARINA VILLAGE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-6427
Mailing Address - Country:US
Mailing Address - Phone:510-337-7950
Mailing Address - Fax:510-337-7969
Practice Address - Street 1:12440 FIRESTONE BLVD
Practice Address - Street 2:SUITE 3025
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4328
Practice Address - Country:US
Practice Address - Phone:562-929-3868
Practice Address - Fax:562-929-3868
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TELECARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-28
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)