SHADOW MOUNTAIN RECOVERY LLC. NPI 1952973505

NPI Information

  • NPI: 1952973505
  • Provider Name: SHADOW MOUNTAIN RECOVERY LLC.
  • Classification: Substance Abuse Rehabilitation Facility - 324500000X
  • Entity Type: Organization
  • CLIA Number: 32D2109164
  • Address: 1550 BRIDGER RD NE
    RIO RANCHO, NM
    ZIP 87144
  • Phone: (800) 203-8249

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NPI Details

SHADOW MOUNTAIN RECOVERY LLC. is a substance abuse rehabilitation facility in Rio Rancho, NM. The provider is a facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. SHADOW MOUNTAIN RECOVERY LLC. NPI is 1952973505. The provider is registered as an organization entity type.

The provider's business location address is:

1550 BRIDGER RD NE
RIO RANCHO, NM
ZIP 87144-579
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 32D2109164 - other - behavioral health fac 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
1324500000XSubstance Abuse Rehabilitation FacilityYes

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
115453081MEDICAIDNEW MEXICO

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: 11/21/2025

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