MOUNTAIN SHADOWS SUPPORT GROUP INC NPI 1447374020

NPI Information

  • NPI: 1447374020
  • Provider Name: MOUNTAIN SHADOWS SUPPORT GROUP, INC
  • Classification: Nursing Facility/Intermediate Care Facility - 313M00000X
  • Entity Type: Organization
  • Former Legal Business Name: SPECIAL KIDS HOMES-MAGGIE MARSH
  • Address: MAGGIE MARSH
    10467 MORNING RIDGE DR.
    MORENO VALLEY, CA
    ZIP 92557
  • Phone: (760) 743-3714

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NPI Details

MOUNTAIN SHADOWS SUPPORT GROUP, INC is a nursing facility intermediate care facility in Moreno Valley, CA. The provider is an institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. MOUNTAIN SHADOWS SUPPORT GROUP, INC NPI is 1447374020. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Special Kids Homes-maggie Marsh.

The provider's business location address is:

MAGGIE MARSH
10467 MORNING RIDGE DR.
MORENO VALLEY, CA
ZIP 92557
Phone: (760) 743-3714
Fax: (760) 743-9937

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 3/19/2007 and was last updated on 12/26/2007.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1313M00000XNursing Facility/Intermediate Care Facility46989489CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1LTC80273GMEDICAIDCALIFORNIA
2LTC80273FMEDICAIDCALIFORNIA

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: 3/30/2025

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