NPIMap

Organization Active NPI

Mateo Lodge, Inc.

  • Mental Illness Community Based Residential Treatment Facility
  • Redwood City, CA
National Provider Identifier
1447393202
Registry record updated Jun 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
MATEO LODGE, INC.
Practice address
164 Poplar Ave
Redwood City, CA 94061-3013
Phone
(650) 568-9006
NPI assigned
Feb 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2008

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

Authorized official

Name
Mr. Ian Adamson
Title
Ceo
Phone
(650) 363-8125

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X Primary

Addresses

Primary practice location

164 Poplar Ave
Redwood City, CA 94061-3013

Mailing address

420 Cassia St
Redwood City, CA 94063-2011

Other names 1

  • Poplar 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.

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": "1214265600000",
    "number": "1447393202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 CASSIA ST",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940632011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 POPLAR AVE",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940613013",
            "telephone_number": "650-568-9006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATEO LODGE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2008-06-24",
        "status": "A",
        "authorized_official_last_name": "ADAMSON",
        "authorized_official_first_name": "IAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "650-363-8125",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Poplar House",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Redwood City, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2008; 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.