1780913657 NPI number — TELECARE MENTAL HEALTH SERVICES OF WASHINGTON, INC

Table of content: (NPI 1780913657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780913657 NPI number — TELECARE MENTAL HEALTH SERVICES OF WASHINGTON, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TELECARE MENTAL HEALTH SERVICES OF WASHINGTON, 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:
1780913657
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2011
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:
94501-6427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-337-7950
Provider Business Mailing Address Fax Number:
510-337-7969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9601 STEILACOOM BLVD SW
Provider Second Line Business Practice Location Address:
BLDG 27
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98498-7212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-589-5334
Provider Business Practice Location Address Fax Number:
253-584-1508
Provider Enumeration Date:
12/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LANGFELD
Authorized Official First Name:
MARSHALL
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO, VP
Authorized Official Telephone Number:
510-337-7950

Provider Taxonomy Codes

  • Taxonomy code: 323P00000X , with the licence number:  RTF.FS.60118424 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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