CORDILLERAS MENTAL HEALTH CORPORATION (NPI# 1063509123) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063509123 |
| Entity Type | Organization |
| Organization Name | CORDILLERAS MENTAL HEALTH CORPORATION |
| Other Organization Name | CORDILLERAS MENTAL HEALTH SERVICES |
| Practice Address |
200 Edmonds Rd Redwood City CA 94062-3813 |
| Mailing Address |
1080 Marina Village Parkway Suite 100 Alameda CA 94501-1078 |
| Practice Telephone | 6503671890 |
| Practice Fax Number | 6503696465 |
| Mailing Telephone | 5103377950 |
| Mailing Fax Number | 5103377969 |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2016-03-04 |
| Authorized Official Name | MARSHALL LANGFELD (CFO/ SVP) |
| Authorized Official Telephone | 5103377950 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | DMH 02 68 015 | CA | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | MEDICAID | ZZR18511G | 01 |
| Other Name | Type Code |
|---|---|
| Cordilleras Mental Health Services | Doing Business As Name - Organization |
| Street Address |
200 EDMONDS RD |
| City | REDWOOD CITY |
| State | CA |
| Zip Code | 94062-3813 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942801493 | Sherry Chat Bautista | Registered Nurse | 200 Edmonds Rd, Redwood City, CA 94062-3813 | 2020-11-02 |
| 1124633524 | Jamal Perry | Counselor | 200 Edmonds Rd, Redwood City, CA 94062-3813 | 2020-09-11 |
| 1427662162 | Ivy Mecano | Registered Nurse | 200 Edmonds Rd, Redwood City, CA 94062-3813 | 2020-09-01 |
| 1265044077 | Kristina Antonia Ghiglieri | Marriage & Family Therapist | 200 Edmonds Rd, Redwood City, CA 94062-3813 | 2020-08-21 |
| 1043822463 | Matthew Thomas Wynne | Counselor | 200 Edmonds Rd, Redwood City, CA 94062-3813 | 2020-08-18 |
| 1619589256 | Fatima Culha | Registered Nurse | 200 Edmonds Rd, Redwood City, CA 94062-3813 | 2020-08-17 |
| 1407468028 | Herbert Barnuevo | Registered Nurse | 200 Edmonds Rd, Redwood City, CA 94062-3813 | 2020-08-17 |
| 1760093694 | Nelia L Lastimosa-jaramillo | Registered Nurse | 200 Edmonds Rd, Redwood City, CA 94062-3813 | 2020-08-13 |
| 1548871494 | Rachel Green | Registered Nurse | 200 Edmonds Rd, Redwood City, CA 94062-3813 | 2020-08-13 |
| 1477164770 | Sharene Rodamaker | Marriage & Family Therapist | 200 Edmonds Rd, Redwood City, CA 94062-3813 | 2020-08-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063051803 | Birch Clinic Corporation | Acupuncturist | 39b Birch St, Redwood City, CA 94062 | 2019-12-26 |
| 1376084459 | Sneha Kadkol | Physical Therapist | 2944 Broadway Street, Redwood City, CA 94062 | 2017-03-09 |
| 1376081166 | B. Annye Rothenberg | Psychologist | 3943 Jefferson Ave., Emerald Hills, CA 94062 | 2017-02-01 |
| 1922410406 | Sheree Campbell | Psychologist | 40a Corto Ln, Woodside, CA 94062 | 2014-06-02 |
| 1902188832 | Delmar J Smith | Physician Assistant | 2900 Whipple Ave Ste 132, Redwood City, CA 94062 | 2011-09-16 |
| 1902192974 | Mariana Garcia | Counselor | 500 Allerton Street, Redwood City, CA 94062 | 2011-06-28 |
| 1386938264 | Julie Freschi | Physical Therapist | 3674 Sand Hill Rd, Woodside, CA 94062 | 2011-06-08 |
| 1669763702 | Jacqueline M Phillips | Pediatrics | 2979 Woodside Road, Woodside, CA 94062 | 2011-04-24 |
| 1396041208 | Arch Street Medical Associates | General Practice | 143 Birch Street, Redwood City, CA 94062 | 2011-02-10 |
| 1174843916 | Priyasheelta Nand | Internal Medicine | 2950 Whipple Avenue, Suite 3, Redwood City, CA 94062 | 2010-06-03 |
| Find all providers in zip 94062 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | 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. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023556255 | Amanda Johnson | Community Based Residential Treatment Facility, Mental Illness | 1442 Valota Rd, Redwood City, CA 94061-2620 | 2017-02-08 |
| 1447393202 | Mateo Lodge, Inc. | Community Based Residential Treatment Facility, Mental Illness | 164 Poplar Ave, Redwood City, CA 94061-3013 | 2007-02-14 |
| 1740321132 | Mateo Lodge, Inc. | Community Based Residential Treatment Facility, Mental Illness | 420 Cassia St, Redwood City, CA 94063-2011 | 2007-02-09 |
| 1043860760 | Tyler Reese Turner Harvey | Community Based Residential Treatment Facility, Mental Illness | 248 Redwood Ave, Redwood City, CA 94061 | 2019-09-14 |
| 1851779615 | Edgewood Suites | Community Based Residential Treatment Facility, Mental Illness | 200 Edmonds Rd, Redwood City, CA 94062-3813 | 2015-05-13 |
| 1982033486 | Telecare Corporation | Community Based Residential Treatment Facility, Mental Illness | 200 Edmonds Rd, Redwood City, CA 94062-3813 | 2013-11-05 |
| 1497085138 | Canyon Oaks Youth Center | Community Based Residential Treatment Facility, Mental Illness | 400 Edmonds Rd, Redwood City, CA 94062-3803 | 2009-12-31 |
| 1619155942 | San Mateo County | Community Based Residential Treatment Facility, Mental Illness | 400 Edmonds Rd, Redwood City, CA 94062-3803 | 2008-02-08 |
| 1134343262 | The Cordilleras Corporation | Community Based Residential Treatment Facility, Mental Illness | 200 Edmonds Rd, Redwood City, CA 94062-3813 | 2007-04-12 |
| 1477695377 | Mateo Lodge, Inc. | Community Based Residential Treatment Facility, Mental Illness | 695 5th Ave, Redwood City, CA 94063-3818 | 2007-02-14 |
| Find all providers in REDWOOD CITY | ||||
| City | REDWOOD CITY |
| Zip Code | 94062 |
Please comment or provide details below to improve the information on CORDILLERAS MENTAL HEALTH CORPORATION.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.