Provider Demographics
NPI:1780913657
Name:TELECARE MENTAL HEALTH SERVICES OF WASHINGTON, INC
Entity type:Organization
Organization Name:TELECARE MENTAL HEALTH SERVICES OF WASHINGTON, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO, VP
Authorized Official - Prefix:
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGFELD
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 1:9601 STEILACOOM BLVD SW
Practice Address - Street 2:BLDG 27
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98498-7212
Practice Address - Country:US
Practice Address - Phone:253-589-5334
Practice Address - Fax:253-584-1508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARTF.FS.60118424323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8891328Medicare PIN