Organization
MATEO LODGE, INC.
Active
Parent organization
MATEO LODGE, INC.
Other names
Wally's Place
Organization subpart
Yes
Provider details
NPI number
Legal business name
MATEO LODGE, INC.
Authorized official
MR. IAN ADAMSON (CEO)
(650) 363-8125
Entity
Organization
Contact information
Practice address
695 5TH AVE, REDWOOD CITY, CA 94063-3818
(650) 568-9006
Mailing address
695 5TH AVE, REDWOOD CITY, CA 94063-3818
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
410508908
CA
Other
Enumeration date
02/14/2007
Last updated
08/04/2020
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