05D2267003 CLIA NUMBER - MOUNTAIN SHADOWS SUPPORT GROUP

Laboratory Demographics

CLIA Number: 05D2267003

Facility Name: MOUNTAIN SHADOWS SUPPORT GROUP

Facility Address:
2067 W EL NORTE PARKWAY
ESCONDIDO, CA
ZIP 92026
Get Directions

Facility Phone Number: 760 743-3714

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1346365590

Taxonomy: 315P00000X - Intermediate Care Facility, Intellectual Disabilities
An intermediate care facility providing services for individuals with intellectual disabilities.

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
CertificateType	4
CertificateEffectiveDate	8/18/2022
CertificateExpirationDate	8/17/2024
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

This page was last updated on: 4/23/2024