Healthcare Provider Details

I. General information

NPI: 1043056245
Provider Name (Legal Business Name): CIELOMAR RECOVERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 CYPRESS AVE
MOSS BEACH CA
94038-9645
US

IV. Provider business mailing address

323 CYPRESS AVE
MOSS BEACH CA
94038-9645
US

V. Phone/Fax

Practice location:
  • Phone: 650-222-7933
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW KECK
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 650-750-6633