MATEO LODGE, INC. (NPI# 1447393202) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447393202 |
| Entity Type | Organization |
| Organization Name | MATEO LODGE, INC. |
| Other Organization Name | POPLAR HOUSE |
| Practice Address |
164 Poplar Ave Redwood City CA 94061-3013 |
| Mailing Address |
420 Cassia St Redwood City CA 94063-2011 |
| Practice Telephone | 6505689006 |
| Enumeration Date | 2007-02-14 |
| 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 | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Poplar House | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255474920 | Mateo Lodge, Inc. | Community Based Residential Treatment Facility, Mental Illness | 232 S Humboldt St, San Mateo, CA 94401-2954 | 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 |
| 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 |
164 POPLAR AVE |
| City | REDWOOD CITY |
| State | CA |
| Zip Code | 94061-3013 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962044933 | Klaire Marie Finlayson | Technician | 628 Iris Street, Redwood City, CA 94061 | 2019-10-11 |
| 1568010148 | Shieh and Luo Dental Group | Dentist | 801 Woodside Rd #3, Suite #3, Redwood City, CA 94061 | 2019-08-28 |
| 1518433432 | Jacqueline Tumalan | Lactation Consultant, Non-RN | 267 Vera Avenue, Redwood City, CA 94061 | 2018-10-18 |
| 1508242314 | Althea Rogers | Registered Nurse | 1695 Hampton Ave, Redwood City, CA 94061 | 2015-08-04 |
| 1073881975 | Rebecca Lynn Cordero | Marriage & Family Therapist | 1690 Woodside Road, Suite 112, Redwood City, CA 94061 | 2011-12-06 |
| 1720362379 | Brendan James Murray | Counselor | 1614 Hudson St #203, Redwood City, CA 94061 | 2011-09-30 |
| 1770800245 | Gerald Cera | Internal Medicine | 1011 Whitehall Ln., Redwood City, CA 94061 | 2010-04-23 |
| 1144407743 | Pamela Burford | Case Manager/Care Coordinator | 2648 International Bld, Oakland, CA 94061 | 2008-01-25 |
| 1235347634 | Charles Robert Carter | Dentist | 1391 Woodside Rd Suite 210, Redwood City, CA 94061 | 2007-05-18 |
| 1255437521 | Doreen Weissman Landes | Marriage & Family Therapist | 61 Renato Court, Suite 20, Redwood City, CA 94061 | 2006-09-15 |
| Find all providers in zip 94061 | ||||
| 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 |
| 1740321132 | Mateo Lodge, Inc. | Community Based Residential Treatment Facility, Mental Illness | 420 Cassia St, Redwood City, CA 94063-2011 | 2007-02-09 |
| 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 | 94061 |
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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.