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MOUNTAIN SHADOWS SUPPORT GROUP NPI 1104280361


NPI Information

NPI: 1104280361
Provider Name: MOUNTAIN SHADOWS SUPPORT GROUP

Doing Business As: MOUNTAIN SHADOWS SPECIAL KIDS HOMES-GARTH

Classification: Intermediate Care Facility, Mentally Retarded - 315P00000X
Entity Type: Organization
Address:
4287 GARTH ST
JURUPA VALLEY, CA
ZIP 92509
Phone: (760) 743-3714
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MOUNTAIN SHADOWS SUPPORT GROUP is an intermediate care facility mentally retarded in Jurupa Valley, CA. The provider is (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. MOUNTAIN SHADOWS SUPPORT GROUP NPI is 1104280361. The provider is registered as an organization entity type.
The provider Is Doing Business As Mountain Shadows Special Kids Homes-garth.

The provider's business location address is:

4287 GARTH ST
JURUPA VALLEY, CA
ZIP 92509-316
Phone: (760) 743-3714

The provider's authorized official is Lupe Bryson .
The authorized official title is Business Office Manager and has the following contact phone number (760) 743-3714.

The enumeration date for this NPI number is 4/13/2016 and was last updated on 4/19/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1315P00000XIntermediate Care Facility, Mentally RetardedYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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