COUNTY OF SAN MATEO (NPI# 1730721929) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730721929 |
| Entity Type | Organization |
| Organization Name | COUNTY OF SAN MATEO |
| Other Organization Name | ELYSIAN STRTP COUNTY OF SAN MATEO |
| Practice Address |
31 Tower Road San Mateo CA 94402 |
| Mailing Address |
1 Davis Drive Attn: Natasha Bourbonnais Belmont CA 94002 |
| Practice Telephone | 6503125320 |
| Practice Fax Number | 6505722414 |
| Mailing Telephone | 6508026583 |
| Mailing Fax Number | 6505923056 |
| Enumeration Date | 2019-10-09 |
| Last Update Date | 2019-10-24 |
| Authorized Official Name | MS. NATASHA BOURBONNAIS (HUMAN SERVICES MANAGER II) |
| Authorized Official Telephone | 6508026583 |
| Authorized Official Credential | LCSW |
| Is Organization Subpart | Y |
| Parent Organization Name | COUNTY OF SAN MATEO |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Elysian STRTP County of San Mateo | Doing Business As Name - Organization |
| San Mateo County Human Services Agency Short Term Residential Theraput | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1669032868 | County of San Mateo | Clinic/Center | 222 Paul Scannell Dr., San Mateo, CA 94402 | 2019-06-19 |
| 1427242163 | County of San Mateo | Community/Behavioral Health | 2000 Alameda De Las Pulgas Ste 280, San Mateo, CA 94403-1289 | 2007-09-05 |
| 1568540557 | County of San Mateo | Clinic/Center | 200 James Ave, Redwood City, CA 94062-5123 | 2006-11-01 |
| 1023196011 | County of San Mateo | Clinic/Center | 350 90th Street, Daly City, CA 94015-1634 | 2006-11-01 |
| 1215029087 | County of San Mateo | Clinic/Center | 300 Piedmont Ave, San Bruno, CA 94066-3959 | 2006-09-29 |
| 1811089659 | County of San Mateo | Clinic/Center | 825 Southwood Dr, South San Francisco, CA 94080-3106 | 2006-09-29 |
| 1215029079 | County of San Mateo | Clinic/Center | 199 Churchill Ave, Woodside, CA 94062-1151 | 2006-09-29 |
| 1700978574 | County of San Mateo | Clinic/Center | 699 Serramonte Blvd, Room 300, Daly City, CA 94015-4132 | 2006-09-29 |
| Street Address |
31 TOWER ROAD |
| City | SAN MATEO |
| State | CA |
| Zip Code | 94402 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174647382 | Saila Zulma Martinez | Social Worker | 31 Tower Road, San Mateo, CA 94402 | 2007-03-16 |
| 1982236089 | Nicole Marie Daly | Social Worker | 31 Tower Road, San Mateo, CA 94402 | 2020-02-06 |
| 1518598648 | Vincenza Ferreira | Counselor | 31 Tower Road, San Mateo, CA 94402 | 2020-01-28 |
| 1417588542 | Donovan David Fones | Social Worker | 31 Tower Road, San Mateo, CA 94402 | 2020-01-28 |
| 1811528938 | Lorena Torres | Social Worker | 31 Tower Road, San Mateo, CA 94402 | 2020-01-28 |
| 1598200776 | Olisha Hodges | Social Worker | 31 Tower Road, San Mateo, CA 94402 | 2016-12-27 |
| 1821416249 | Xelina Miramontes | Marriage & Family Therapist | 31 Tower Road, San Mateo, CA 94402 | 2014-04-02 |
| 1568700680 | Mari Kugoh Evers | Social Worker | 31 Tower Road, San Mateo, CA 94402 | 2013-01-24 |
| 1821341199 | Melissa Noemy Rodriguez | Counselor | 31 Tower Road, San Mateo, CA 94402 | 2012-10-23 |
| 1114274396 | Rebeca Fletes Aceret | Marriage & Family Therapist | 31 Tower Road, San Mateo, CA 94402 | 2012-08-07 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477154227 | Mark Cameron Head | Non-emergency Medical Transport (VAN) | 331 Sonora Drive, San Mateo, CA 94402 | 2020-11-06 |
| 1669032868 | County of San Mateo | Clinic/Center | 222 Paul Scannell Dr., San Mateo, CA 94402 | 2019-06-19 |
| 1417443755 | Suen Leung | Counselor | 800 Edinburgh St, San Mateo, CA 94402 | 2018-07-10 |
| 1760997902 | Blue Lotus Connection | Point of Service | 1700 S Amphlett Blvd, Ste 250b, San Mateo, CA 94402 | 2017-12-11 |
| 1982122503 | Madeline Pielert | Social Worker | 1670 S. Amphlett Blvd. 115, San Mateo, CA 94402 | 2017-09-04 |
| 1629512348 | Travis Woodmansee | Marriage & Family Therapist | 419 S El Dorado St, San Mateo, CA 94402 | 2016-12-14 |
| 1669820858 | Mohan Sundareson | Pediatrics | 1638 South Grant St, San Mateo, CA 94402 | 2016-05-27 |
| 1457712572 | New Life Acupuncture Clinic | Acupuncturist | 1720 South Amphlett Blvd # 168, San Mateo, CA 94402 | 2016-03-17 |
| 1871951434 | Nanami Oba | Physical Therapy Assistant | 20 Bennigton Dr., San Mateo, CA 94402 | 2016-02-10 |
| 1780059733 | Adrianna Cimera | Behavioral Analyst | 1710 South Amphlett Blvd, Suite 314, San Mateo, CA 94402 | 2015-12-02 |
| Find all providers in zip 94402 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144820499 | Catholic Charities of The Diocese of Oakland | Residential Treatment Facility, Emotionally Disturbed Children | 3700 Dorisa Ave, Oakland, CA 94605-4941 | 2020-10-27 |
| 1922607944 | Inspire A Youth, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 7556 Avenida Baja, Riverside, CA 92509-3449 | 2020-10-21 |
| 1235736554 | Yvonne Dionne Robinson | Residential Treatment Facility, Emotionally Disturbed Children | 1223 E Helmick St, Carson, CA 90746-3163 | 2020-10-09 |
| 1740897784 | Paradise Adolescent Home, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 602 Woodlark Dr, Suisun City, CA 94585-2244 | 2020-09-24 |
| 1548877657 | T & T House of Champions | Residential Treatment Facility, Emotionally Disturbed Children | 2115 High St, Oakland, CA 94601-4335 | 2020-09-23 |
| 1902412182 | Paradise Adolescent Home, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 136 Valdivia Cir, San Ramon, CA 94583-2228 | 2020-09-22 |
| 1073128492 | Samuel Campbell Jr. | Residential Treatment Facility, Emotionally Disturbed Children | 4200 Crescent Rock Ln, Bakersfield, CA 93311-2860 | 2020-09-11 |
| 1336753433 | Aaron's Boys Home | Residential Treatment Facility, Emotionally Disturbed Children | 5805 Capistrano Ave Ste E, Atascadero, CA 93422-7218 | 2020-09-04 |
| 1699389452 | Millie's Youth Services, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 2512 Havenscourt Blvd, Oakland, CA 94605-1935 | 2020-08-31 |
| 1538779871 | Hidden Treasures Foundation, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 1240 W 13th Ave, Escondido, CA 92025-5560 | 2020-08-02 |
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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.