NPIMap

Organization Active NPI

Mateo Lodge, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • San Mateo, CA
National Provider Identifier
1255474920
Registry record updated Aug 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
MATEO LODGE, INC.
Practice address
232 S Humboldt St
San Mateo, CA 94401-2954
Phone
(650) 568-9006
NPI assigned
Feb 14, 2007
Last updated
Aug 12, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2025

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

Authorized official

Name
Mary Beth Sandoval
Title
Ceo
Phone
(650) 703-3462

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary
Mental Illness Community Based Residential Treatment Facility 320800000X 415600236 CA

Addresses

Primary practice location

232 S Humboldt St
San Mateo, CA 94401-2954

Mailing address

232 S Humboldt St
San Mateo, CA 94401-2954

Other names 1

  • Humboldt House Other name

National Provider Directory

National Provider Directory
Tax ID family
Mateo Lodge Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754956800000",
    "number": "1255474920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "232 S HUMBOLDT ST",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944012954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "232 S HUMBOLDT ST",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944012954",
            "telephone_number": "650-568-9006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATEO LODGE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2025-08-12",
        "certification_date": "2025-08-12",
        "status": "A",
        "authorized_official_last_name": "SANDOVAL",
        "authorized_official_first_name": "MARY BETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "650-703-3462"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "CA",
            "license": "415600236",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Humboldt House",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Mateo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2025; 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.