Basic Information
| Provider Information | |||||||||
| NPI: | 1851594493 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TELECARE CORPORATION | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | TELECARE SAN DIEGO REACH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 446 26TH ST | ||||||||
| Address2: | 6TH FLOOR | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921023026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6193982181 | ||||||||
| FaxNumber: | 6193982171 | ||||||||
| Practice Location | |||||||||
| Address1: | 446 26TH ST | ||||||||
| Address2: | 6TH FLOOR | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921023026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6193982181 | ||||||||
| FaxNumber: | 6193982171 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CHRISTIANCE | ||||||||
| AuthorizedOfficialFirstName: | DAPHNE | ||||||||
| AuthorizedOfficialMiddleName: | SUE | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINNESS OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6193982181 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | CA | Y | Hospitals | Psychiatric Hospital |
No ID Information.