NPIMap

Organization Active NPI

Mateo Lodge, Inc.

  • Mental Illness Community Based Residential Treatment Facility
  • Redwood City, CA
National Provider Identifier
1477695377
Registry record updated Aug 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
410508908 Issued in CA
Legal business name
MATEO LODGE, INC.
Practice address
695 5TH Ave
Redwood City, CA 94063-3818
Phone
(650) 568-9006
NPI assigned
Feb 14, 2007
Last updated
Aug 4, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
MATEO LODGE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 4, 2020

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

Authorized official

Name
Mr. Ian AdamsonNPI 1942355532
Title
Ceo
Phone
(650) 363-8125

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 410508908 CA Primary

Addresses

Primary practice location

695 5TH Ave
Redwood City, CA 94063-3818

Mailing address

695 5TH Ave
Redwood City, CA 94063-3818

Other names 1

  • Wally's Place Other name

National Provider Directory

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

Other organizations with this tax ID 4

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

Practitioners & affiliated clinicians

Practitioners 12

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": "1596499200000",
    "number": "1477695377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "695 5TH AVE",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940633818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "695 5TH AVE",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940633818",
            "telephone_number": "650-568-9006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATEO LODGE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MATEO LODGE, INC.",
        "enumeration_date": "2007-02-14",
        "last_updated": "2020-08-04",
        "certification_date": "2020-08-04",
        "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": "CA",
            "license": "410508908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wally's Place",
            "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 Aug 4, 2020; 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.