Healthcare Provider Details

I. General information

NPI: 1972967974
Provider Name (Legal Business Name): CIELO HOUSE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 CYPRESS AVE
MOSS BEACH CA
94038
US

IV. Provider business mailing address

750 EL CAMINO REAL
BURLINGAME CA
94010
US

V. Phone/Fax

Practice location:
  • Phone: 650-563-9442
  • Fax: 866-398-5858
Mailing address:
  • Phone: 650-739-6001
  • Fax: 866-398-5858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ELLIOTT RICHELSON
Title or Position: DIRECTOR, PRESIDENT
Credential: M.D.
Phone: 252-733-7374