MOUNTAIN SHADOWS SUPPORT GROUP INC. NPI 1912022161

NPI Information

  • NPI: 1912022161
  • Provider Name: MOUNTAIN SHADOWS SUPPORT GROUP, INC.
  • Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
  • Entity Type: Organization
  • Doing Business As: MTN.SHADOWS COMMUNITY HOMES - CEDAR
  • Address: 2067 W EL NORTE PKWY
    ESCONDIDO, CA
    ZIP 92026
  • Phone: (760) 743-3714

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NPI Details

MOUNTAIN SHADOWS SUPPORT GROUP, INC. is an intermediate care facility mentally retarded in Escondido, CA. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. MOUNTAIN SHADOWS SUPPORT GROUP, INC. NPI is 1912022161. The provider is registered as an organization entity type.
The provider Is Doing Business As Mtn.shadows Community Homes - Cedar.

The provider's business location address is:

2067 W EL NORTE PKWY
ESCONDIDO, CA
ZIP 92026-810
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 3/20/2007 and was last updated on 8/22/2020.

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
1315P00000XIntermediate Care Facility, Intellectual Disabilities46989489CALIFORNIAYes

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
1LTC60157IMEDICAIDCALIFORNIA

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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