Basic Information
| Provider Information | |||||||||
| NPI: | 1780913657 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TELECARE MENTAL HEALTH SERVICES OF WASHINGTON, INC | ||||||||
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| OtherOrganizationName: | TELECARE RECOVERY PARTNERSHIP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1080 MARINA VILLAGE PKWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ALAMEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945016427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103377950 | ||||||||
| FaxNumber: | 5103377969 | ||||||||
| Practice Location | |||||||||
| Address1: | 9601 STEILACOOM BLVD SW | ||||||||
| Address2: | BLDG 27 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984987212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535895334 | ||||||||
| FaxNumber: | 2535841508 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2009 | ||||||||
| LastUpdateDate: | 01/27/2011 | ||||||||
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| AuthorizedOfficialLastName: | LANGFELD | ||||||||
| AuthorizedOfficialFirstName: | MARSHALL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO, VP | ||||||||
| AuthorizedOfficialTelephone: | 5103377950 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 323P00000X | RTF.FS.60118424 | WA | Y | Residential Treatment Facilities | Psychiatric Residential Treatment Facility |
No ID Information.