Healthcare Provider Details

I. General information

NPI: 1083569941
Provider Name (Legal Business Name): CALIFORNIA CLUBHOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2191 S EL CAMINO REAL
SAN MATEO CA
94403-1854
US

IV. Provider business mailing address

PO BOX 971
SAN MATEO CA
94403-0571
US

V. Phone/Fax

Practice location:
  • Phone: 650-539-3345
  • Fax:
Mailing address:
  • Phone: 650-539-3345
  • 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

VIII. Authorized Official

Name: LISA LITSEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 650-539-3345