Provider Demographics
NPI:1780926964
Name:TELECARE CORPORATION
Entity type:Organization
Organization Name:TELECARE CORPORATION
Other - Org Name:<UNAVAIL>
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:510-747-0552
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:94501-1078
Mailing Address - Country:US
Mailing Address - Phone:510-337-7950
Mailing Address - Fax:
Practice Address - Street 1:2250 SOQUEL AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-1402
Practice Address - Country:US
Practice Address - Phone:831-600-2801
Practice Address - Fax:831-600-2820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA131235OtherMEDICARE PTAN - PART B
CACA131235OtherMEDICARE PTAN - PART B
CA054152OtherMEDICARE, OSCAR/CERTIFICATION
CA054152OtherMEDICARE, OSCAR/CERTIFICATION