NPIMap

Organization Active NPI

Telecare Corporation

  • Psychiatric Hospital
  • San Leandro, CA
National Provider Identifier
1053538348
Registry record updated Mar 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
02016039 Issued in CA
Legal business name
TELECARE CORPORATION
Practice address
2050 Fairmont Dr
2 BLDG. C-D
San Leandro, CA 94578-1001
Phone
(510) 895-5502
Fax
(510) 895-7404
NPI assigned
Apr 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 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
Psychiatric Hospital 283Q00000X 02016039 CA Primary

Addresses

Primary practice location

2050 Fairmont Dr
2 BLDG. C-D
San Leandro, CA 94578-1001

Mailing address

1080 Marina Village Pkwy
Suite 100
Alameda, CA 94501-1078
Phone (510) 337-7950

Other identifiers 2

IdentifierTypeStateIssuer
05 4149OtherCAMEDICARE
05 4149MedicaidCA

Other names 1

  • Telecare Willow Rock Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100915000253 CA Part A Provider - Hospital 6901820380 Practice locations: San Leandro, CA

Hospital certification: CCN 054149

Legal name
TELECARE CORPORATION
Doing business as
WILLOW ROCK CENTER
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Aug 12, 2011
Last certification
Jul 20, 2011
Beds
16
Ownership / control type
Private (for profit)
Organization structure
CorporationProprietary
Incorporated
Aug 23, 1965 in CA
Enrollment address
2050 Fairmont Dr
San Leandro, CA 94578-1001
Other Hospital Practice Location
Hospital subgroups
Psychiatric

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospital

Medicare Care Compare
Listed as
Willow Rock CenterCCN 054149
Type
Psychiatric
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
Telecare Soar162 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 19

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 19

Locations

2050 Fairmont Dr
Bldg Cd
Castro Valley, CA 94578
Phone (510) 895-5502

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Anita Barnes Individual Corporate Officer Jan 1, 2020
Leslie Davis Individual Corporate Officer Jan 1, 2019
W-2 Managing Employee Jan 1, 2019
Lorena Lopez Individual W-2 Managing EmployeeProvider Relations Supervisor Aug 25, 2015 100%
Anne L Bakar Individual 5% Or Greater Direct Ownership InterestCeo Aug 24, 1980 100%
Corporate Officer Aug 24, 1980
Corporate Director Aug 24, 1980
W-2 Managing Employee Aug 24, 1980

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Morton Bakar CenterCherryland, CA, CCN 555611 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Oct 5, 1994

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677628800000",
    "number": "1053538348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1080 MARINA VILLAGE PKWY",
            "address_2": "SUITE 100",
            "city": "ALAMEDA",
            "state": "CA",
            "postal_code": "945011078",
            "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": "2050 FAIRMONT DR",
            "address_2": "2 BLDG. C-D",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945781001",
            "telephone_number": "510-895-5502",
            "fax_number": "510-895-7404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TELECARE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2023-03-01",
        "certification_date": "2023-03-01",
        "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": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "CA",
            "license": "02016039",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "05 4149",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05 4149",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Telecare Willow Rock Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Telecare Willow Rock Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Leandro, CA

Sources for this page

Verify at the official NPI Registry.