CANYON OAKS YOUTH CENTER (NPI# 1497085138) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497085138 |
| Entity Type | Organization |
| Organization Name | CANYON OAKS YOUTH CENTER |
| Practice Address |
400 Edmonds Rd Redwood City CA 94062-3803 |
| Mailing Address |
9031 Castlewood St Oakland CA 94605-4407 |
| Practice Telephone | 6508391810 |
| Mailing Telephone | 5102132592 |
| Enumeration Date | 2009-12-31 |
| Last Update Date | 2009-12-31 |
| Authorized Official Name | MR. TIM R. HOLECHEK (RESIDENTAL COUNSELOR RELIEF) |
| Authorized Official Telephone | 6508391810 |
| Authorized Official Credential | LCSW |
| 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 |
| Street Address |
400 EDMONDS RD |
| City | REDWOOD CITY |
| State | CA |
| Zip Code | 94062-3803 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568561058 | County of San Mateo | Community/Behavioral Health | 400 Edmonds Rd, Redwood City, CA 94062 | 2006-09-21 |
| 1720558448 | Damon William Jones | Counselor | 400 Edmonds Rd, Redwood City, CA 94062-3803 | 2018-11-26 |
| 1952879488 | Claudia Gabriela Benitez | Counselor | 400 Edmonds Rd, Redwood City, CA 94062-3803 | 2018-11-02 |
| 1003383571 | Remberto Calero Jr. | Counselor | 400 Edmonds Rd, Redwood City, CA 94062-3803 | 2018-11-01 |
| 1831617331 | Iris Godinez | Marriage & Family Therapist | 400 Edmonds Rd, Redwood City, CA 94062-3803 | 2017-09-05 |
| 1699223297 | Lauren Caraotta | Counselor | 400 Edmonds Rd, Redwood City, CA 94062-3803 | 2016-09-13 |
| 1750712022 | Isabel Araceli Cabezas | Student in an Organized Health Care Education/Training Program | 400 Edmonds Rd, Redwood City, CA 94062-3803 | 2013-12-11 |
| 1356637144 | Brian Deburr | Counselor | 400 Edmonds Rd, Redwood City, CA 94062-3803 | 2011-06-21 |
| 1790006740 | Lee Keenan | Counselor | 400 Edmonds Rd, Redwood City, CA 94062-3803 | 2010-06-14 |
| 1215255963 | Pedro Hernandez | Counselor | 400 Edmonds Rd, Redwood City, CA 94062-3803 | 2010-05-05 |
| 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 |
| 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 |
| 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 |
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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.