SHADOW MOUNTAIN RECOVERY LLC. NPI 1487226031

NPI Information

NPI: 1487226031
Provider Name: SHADOW MOUNTAIN RECOVERY LLC.
Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

CLIA Number: 32D2179728

Address:
7005 PROSPECT PL NE
ALBUQUERQUE, NM
ZIP 87110
Phone: (800) 203-8249
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SHADOW MOUNTAIN RECOVERY LLC. is a rehabilitation and substance use disorder clinic center in Albuquerque, NM. SHADOW MOUNTAIN RECOVERY LLC. NPI is 1487226031. The provider is registered as an organization entity type.

The provider's business location address is:

7005 PROSPECT PL NE
ALBUQUERQUE, NM
ZIP 87110-311
Phone: (800) 203-8249

The provider's authorized official is Jackie Holub .
The authorized official title is Vp, Operations and has the following contact phone number (925) 389-8591.

The CLIA number assigned to this NPI record is 32D2179728 - other - substance abuse treatment with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/13/2021 and was last updated on 7/13/2021.

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
1	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder			Yes

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: 4/28/2024

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