NPIMap

Organization Active NPI

San Mateo County Behavioral Health and Recovery Services

Doing business as Capuchino TDS

  • Adolescent and Children Mental Health Clinic/Center
  • San Bruno, CA
National Provider Identifier
1063939171
Registry record updated Dec 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
SAN MATEO COUNTY BEHAVIORAL HEALTH AND RECOVERY SERVICES
Doing business as
Capuchino TDS
Practice address
1501 Magnolia Ave
San Bruno, CA 94066-5451
Phone
(650) 558-2778
NPI assigned
Aug 29, 2017
Last updated
Dec 10, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
COUNTY OF SAN MATEOAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jei Africa
Title
Director
Phone
(650) 613-2155

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

1501 Magnolia Ave
San Bruno, CA 94066-5451

Mailing address

1501 Magnolia Ave
San Bruno, CA 94066-5451

Other names 1

  • Capuchino TDS Doing business as

National Provider Directory

National Provider Directory
Tax ID family
San Mateo Medical Center Methadone Treatment Program123 organizations share this tax ID, including this one
Part of
San Mateo Medical Center Methadone Treatment Program

Organizations with this tax ID in the same state 21

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 21

Locations

1501 Magnolia Ave
San Bruno, CA 94066
Phone (650) 558-2778

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733788800000",
    "number": "1063939171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 MAGNOLIA AVE",
            "city": "SAN BRUNO",
            "state": "CA",
            "postal_code": "940665451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 MAGNOLIA AVE",
            "city": "SAN BRUNO",
            "state": "CA",
            "postal_code": "940665451",
            "telephone_number": "650-558-2778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN MATEO COUNTY BEHAVIORAL HEALTH AND RECOVERY SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTY OF SAN MATEO",
        "enumeration_date": "2017-08-29",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A",
        "authorized_official_last_name": "AFRICA",
        "authorized_official_first_name": "JEI",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "650-613-2155"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Capuchino TDS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Capuchino TDS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Bruno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.