Provider Demographics
NPI:1932150281
Name:TELECARE HERITAGE PSYCHIATRIC HEALTHY FACILITY
Entity Type:Organization
Organization Name:TELECARE HERITAGE PSYCHIATRIC HEALTHY FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:510-535-5115
Mailing Address - Street 1:2366 E 27TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-1331
Mailing Address - Country:US
Mailing Address - Phone:510-535-5115
Mailing Address - Fax:510-535-5234
Practice Address - Street 1:2366 E 27TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-1331
Practice Address - Country:US
Practice Address - Phone:510-535-5115
Practice Address - Fax:510-535-5234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2026036283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital