1073601647 NPI number — TELECARE MENTAL HEALTH SERVICES OF OREGON, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073601647 NPI number — TELECARE MENTAL HEALTH SERVICES OF OREGON, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TELECARE MENTAL HEALTH SERVICES OF OREGON, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073601647
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1080 MARINA VILLAGE PKWY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
ALAMEDA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94501-1078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-337-7950
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1605 E LINCOLN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODBURN
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97071-5137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-982-9300
Provider Business Practice Location Address Fax Number:
503-982-9306
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
LORENA
Authorized Official Middle Name:
Authorized Official Title or Position:
PROVIDER RELATIONS SUPERVISOR
Authorized Official Telephone Number:
510-337-7950

Provider Taxonomy Codes

  • Taxonomy code: 323P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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