Provider Demographics
NPI:1972967974
Name:CIELO HOUSE INC
Entity Type:Organization
Organization Name:CIELO HOUSE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-733-7374
Mailing Address - Street 1:750 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010
Mailing Address - Country:US
Mailing Address - Phone:650-739-6001
Mailing Address - Fax:866-398-5858
Practice Address - Street 1:323 CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:MOSS BEACH
Practice Address - State:CA
Practice Address - Zip Code:94038
Practice Address - Country:US
Practice Address - Phone:650-563-9442
Practice Address - Fax:866-398-5858
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CIELO HOUSE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-06
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health