05D2267003 CLIA NUMBER - MOUNTAIN SHADOWS SUPPORT GROUP

Laboratory Demographics

  • CLIA Code: 05D2267003
  • Facility Name: MOUNTAIN SHADOWS SUPPORT GROUP
  • Facility Address: 2067 W EL NORTE PARKWAY
    ESCONDIDO, CA
    ZIP 92026
  • Facility Phone: 760 743-3714
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: MICHAEL N. MARKOPOULOS
  • NPI Number: 1346365590
  • Taxonomy: 315P00000X - Intermediate Care Facility, Intellectual Disabilities

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CLIA Record

Field Name Field Value
CLIA Number 05D2267003
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name MOUNTAIN SHADOWS SUPPORT GROUP
Street 2067 W EL NORTE PARKWAY
City ESCONDIDO
State CA
ZIP 92026
Phone 760 743-3714
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/18/2024
Certificate Expiration Date 8/17/2026
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director MICHAEL N. MARKOPOULOS

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This page was last updated on: 9/29/2025