50D2173522 CLIA NUMBER - TELECARE SHELTON E AND T

Laboratory Demographics

CLIA Number: 50D2173522

Facility Name: TELECARE SHELTON E AND T

Facility Address:
307 W COTA ST
SHELTON, WA
ZIP 98584
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Facility Phone Number: 360 205-8002

Facility Type: Other - EMERGENCY AND TRAUMA

Certificate Type: Waiver

NPI Number: 1134737737

Taxonomy: 320800000X - Community Based Residential Treatment Facility, Mental Illness
A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.

CLIA Record

Field Name	Field Value
CLIA Number	50D2173522
LAB Type	Other - EMERGENCY AND TRAUMA
Facility Name	TELECARE SHELTON E AND T
Street	307 W COTA ST
City	SHELTON
State	WA
ZIP	98584
Phone	360 205-8002
CertificateType	4
CertificateEffectiveDate	10/15/2019
CertificateExpirationDate	4/4/2028
FacilityType	Waiver

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This page was last updated on: 4/23/2024