Provider Demographics
NPI:1962488007
Name:TERI, INC
Entity type:Organization
Organization Name:TERI, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:KILMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-721-1706
Mailing Address - Street 1:251 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-1201
Mailing Address - Country:US
Mailing Address - Phone:760-721-1706
Mailing Address - Fax:760-721-9872
Practice Address - Street 1:251 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-1201
Practice Address - Country:US
Practice Address - Phone:760-721-1706
Practice Address - Fax:760-721-9872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 106S00000X, 235Z00000X
CA310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental IllnessGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC60097FMedicaid
CALTC60482FMedicaid
CALTC60038FMedicaid
CALTC60039FMedicaid
CALTC60037FMedicaid
CALTC60524FMedicaid
CALTC60036FMedicaid
CALTC60100FMedicaid
CALTC60324FMedicaid
CALTC61079FMedicaid