Organization
TELECARE CORPORATION
Active
Other names
AMHS TAO South FSP
Organization subpart
No
Provider details
NPI number
Authorized official
LORENA LOPEZ (PROVIDER RELATIONS SUPERVISOR)
(510) 337-7950
Entity
Organization
Contact information
Practice address
275 EAST BAKER STREET,, SUITE A, COSTA MESA, CA 92626-4566
(714) 361-6760
(714) 361-6768
Mailing address
1080 MARINA VILLAGE PKWY, SUITE 100, ALAMEDA, CA 94501-6427
(510) 337-7950
(510) 337-7969
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CR722M
MEDICARE PTAN
—
Enumeration date
10/12/2012
Last updated
03/06/2023
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