Organization · Type 2 NPI

San Mateo County

Emotionally Disturbed Childrens' Residential Treatment Facility · San Mateo, CA

NPI number 1730721929 Active

Practice location

31 Tower Rd
San Mateo, CA 94402-4000

Call (650) 312-5320 Map

Fax (650) 572-2414

Mailing address

1 Davis Drive, Attn: Natasha Bourbonnais
Belmont, CA 94002

Specialties and licenses

Taxonomy	Code	License
Emotionally Disturbed Childrens' Residential Treatment Facility Primary	322D00000X	None listed

Emotionally Disturbed Childrens' Residential Treatment Facility: A residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently.

6 other providers at this address

NPI record

NPI: 1730721929
Entity type: Organization (Type 2)
Issued: Oct 9, 2019
Last updated: Aug 25, 2022
Status: Active
Subpart: Yes of County of San Mateo

Other names

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Elysian Strtp County of San Mateo · doing business as

Authorized official

Ms. Natasha Bourbonnais, LCSW
Human Services Manager II
(650) 802-6583

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1730721929

San Mateo County's National Provider Identifier is 1730721929, issued on Oct 9, 2019. The primary taxonomy on file is Emotionally Disturbed Childrens' Residential Treatment Facility (322D00000X), and the practice location is in San Mateo, CA. The record was last updated on Aug 25, 2022.