Organization
MATEO LODGE, INC.
Active
Other names
Humboldt House
Organization subpart
No
Provider details
NPI number
Authorized official
MARY BETH SANDOVAL (CEO)
(650) 703-3462
Entity
Organization
Contact information
Practice address
232 S HUMBOLDT ST, SAN MATEO, CA 94401-2954
(650) 568-9006
Mailing address
232 S HUMBOLDT ST, SAN MATEO, CA 94401-2954
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
415600236
CA
Other
Enumeration date
02/14/2007
Last updated
08/12/2025
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