Organization
CORDILLERAS MENTAL HEALTH CORPORATION
Active
Other names
Cordilleras Mental Health Services
Organization subpart
No
Provider details
NPI number
Authorized official
LORENA LOPEZ (PROVIDER RELATIONS SUPERVISOR)
(510) 337-7950
Entity
Organization
Contact information
Practice address
200 EDMONDS RD, REDWOOD CITY, CA 94062-3813
(650) 367-1890
(650) 369-6465
Mailing address
1080 MARINA VILLAGE PARKWAY, SUITE 100, ALAMEDA, CA 94501-1078
(510) 337-7950
(510) 337-7969
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
DMH 02 68 015
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZR18511G
MEDICAID
CA
Enumeration date
10/09/2006
Last updated
03/31/2023
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