NPIMap

Organization Active NPI

Telecare Mental Health Services of Arizona Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Yuma, AZ
National Provider Identifier
1043615412
Registry record updated Mar 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
OTC6996 Issued in AZ
Legal business name
TELECARE MENTAL HEALTH SERVICES OF ARIZONA INC
Practice address
1595 S 1St Ave
Yuma, AZ 85364-4706
Phone
(928) 329-5855
Fax
(928) 329-5904
NPI assigned
Oct 28, 2014
Last updated
Mar 23, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lorena Lopez
Title
Provider Relations Supervisor
Phone
(510) 337-7950

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X OTC6996 AZ Primary

Addresses

Primary practice location

1595 S 1St Ave
Yuma, AZ 85364-4706

Mailing address

1080 Marina Village Parkway
Suite 100
Alameda, CA 94501-1087
Phone (510) 337-7950

Other identifiers 1

IdentifierTypeStateIssuer
986992MedicaidAZ

Other names 1

  • TELECARE YUMA ACT Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150506001505 AZ Part B Supplier - Clinic/Group Practice 6204155674 Receives reassigned benefits from 3 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sierra Vista, AZ; Yuma, AZ

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1595 S 1st Ave
Yuma, AZ 85364
Phone (928) 329-5855

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1414454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679529600000",
    "number": "1043615412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1080 MARINA VILLAGE PARKWAY",
            "address_2": "SUITE 100",
            "city": "ALAMEDA",
            "state": "CA",
            "postal_code": "945011087",
            "telephone_number": "510-337-7950",
            "fax_number": "510-337-7969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1595 S 1ST AVE",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853644706",
            "telephone_number": "928-329-5855",
            "fax_number": "928-329-5904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TELECARE MENTAL HEALTH SERVICES OF ARIZONA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-28",
        "last_updated": "2023-03-23",
        "certification_date": "2023-03-23",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "LORENA",
        "authorized_official_title_or_position": "PROVIDER RELATIONS SUPERVISOR",
        "authorized_official_telephone_number": "510-337-7950"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "AZ",
            "license": "OTC6996",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "986992",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TELECARE YUMA ACT",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "TELECARE YUMA ACT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Yuma, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.