MATEO LODGE, INC. (NPI# 1740321132) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1740321132 |
Entity Type | Organization |
Organization Name | MATEO LODGE, INC. |
Other Organization Name | CASSIA HOUSE |
Practice Address |
420 Cassia St Redwood City CA 94063-2011 |
Practice Telephone | 6503638125 |
Enumeration Date | 2007-02-09 |
Last Update Date | 2008-06-24 |
Authorized Official Name | MR. IAN ADAMSON (CEO) |
Authorized Official Telephone | 6503638125 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | 410507269 | CA | Residential Treatment Facilities |
Other Name | Type Code |
---|---|
Cassia House | Other Name - Individual/Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1447393202 | Mateo Lodge, Inc. | Community Based Residential Treatment Facility, Mental Illness | 164 Poplar Ave, Redwood City, CA 94061-3013 | 2007-02-14 |
1255474920 | Mateo Lodge, Inc. | Community Based Residential Treatment Facility, Mental Illness | 232 S Humboldt St, San Mateo, CA 94401-2954 | 2007-02-14 |
1477695377 | Mateo Lodge, Inc. | Community Based Residential Treatment Facility, Mental Illness | 695 5th Ave, Redwood City, CA 94063-3818 | 2007-02-14 |
1851445423 | Mateo Lodge, Inc. | Community/Behavioral Health | 695 5th Ave, Redwood City, CA 94063-3818 | 2007-01-22 |
Street Address |
420 CASSIA ST |
City | REDWOOD CITY |
State | CA |
Zip Code | 94063-2011 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1659905933 | Kris Eryk Bartolome | Case Manager/Care Coordinator | 420 Cassia St, Redwood City, CA 94063-2011 | 2020-02-26 |
1790340909 | Faith Arca | Community Health Worker | 420 Cassia St, Redwood City, CA 94063-2011 | 2019-05-02 |
1366924946 | Patricia Sandoval | Community Health Worker | 420 Cassia St, Redwood City, CA 94063-2011 | 2018-08-30 |
1386133692 | Austin Paul Matthew Cuellar | Community Health Worker | 420 Cassia St, Redwood City, CA 94063-2011 | 2018-05-02 |
1114453354 | Nicole Brown | Counselor | 420 Cassia St, Redwood City, CA 94063-2011 | 2017-05-09 |
1477892735 | Everett Touse | Counselor | 420 Cassia St, Redwood City, CA 94063-2011 | 2013-02-06 |
1124259908 | Francisco Yapan Alagbate | Counselor | 420 Cassia St, Redwood City, CA 94063-2011 | 2009-07-28 |
1013182096 | Denby Glenn Adamson | Counselor | 420 Cassia St, Redwood City, CA 94063-2011 | 2008-04-29 |
1952507386 | Brian L Reed | Counselor | 420 Cassia St, Redwood City, CA 94063-2011 | 2007-06-22 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1578104378 | Jade Francetich | Psychologist | 450 Broadway St., Pavilion B 2nd Floor, Redwood City, CA 94063 | 2019-10-02 |
1861052060 | County of San Mateo | Clinic/Center | 1300 Maple St., Redwood City, CA 94063 | 2019-06-19 |
1750941977 | County of San Mateo | Clinic/Center | 300 Bradford St., Redwood City, CA 94063 | 2019-06-19 |
1023678661 | Linda K Watanabe | Preventive Medicine | 700 Bay Rd. #2803, Redwood City, CA 94063 | 2019-06-17 |
1235630369 | Waverly Place Apartments, Lp | Case Management | 105 Waverly Place, Redwood City, CA 94063 | 2018-02-23 |
1306371679 | Caely Alise Hambro | Student in an Organized Health Care Education/Training Program | Stanford Dermatology, 430 Broadway, Redwood City, CA 94063 | 2017-04-25 |
1609316736 | Justine Nicole Dela Cruz | Nurse Practitioner | 420 Broadway St # D, Redwood City, CA 94063 | 2017-03-08 |
1336683234 | Babita Chopra | Pharmacist | 2300 Middlefield Road, Redwood City, CA 94063 | 2016-12-12 |
1073065595 | Diana Genoveva Posner I | Counselor | 604 Prince Ave. Ste A, Redwood City, CA 94063 | 2016-11-01 |
1295288264 | Benjamin Dickter | Student in an Organized Health Care Education/Training Program | 1107 2nd Ave, Apt 103, Redwood City, CA 94063 | 2016-07-26 |
Find all providers in zip 94063 |
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 |
1063509123 | Cordilleras Mental Health Corporation | Community Based Residential Treatment Facility, Mental Illness | 200 Edmonds Rd, Redwood City, CA 94062-3813 | 2006-10-09 |
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 | 94063 |
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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.