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General NPI Number Information
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NPI Number | 1043056245
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Entity Type | Organization
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Legal Business Name | CIELOMAR RECOVERY, INC.
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Dates
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Enumeration Date | 07/08/2024
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 323 CYPRESS AVE
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City | MOSS BEACH
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State | CA
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Zip | 94038-9645
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Country | US
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Telephone | 650-222-7933
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Fax |
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Provider Business Mailing Address
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Address Line | 323 CYPRESS AVE
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City | MOSS BEACH
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State | CA
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Zip | 94038-9645
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MATTHEW KECK
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Credential |
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Telephone | 650-750-6633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 310500000X
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Taxonomy Name | Mental Illness Intermediate Care Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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