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Contact Information

MOUNTAIN SHADOWS SUPPORT GROUP, INC
MAGGIE MARSH
10467 MORNING RIDGE DR.
MORENO VALLEY, CA92557
 Phone: 760-743-3714
 Fax: 760-743-9937
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nursing Facility/Intermediate Care Facility

313M00000X A3[10] Other Nursing Facility
Indicates primary specialty

NPI Profile & details for MOUNTAIN SHADOWS SUPPORT GROUP, INC

NPI # 1447374020
LBN Legal business name MOUNTAIN SHADOWS SUPPORT GROUP, INC
Authorized official LUPE BRYSON - (BUSINESS OFFICE MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 03/19/2007
Last updated 12/26/2007 - About 18 years ago
Identifiers
CA License # 46989489
CA Medicaid LTC80273F
CA Medicaid LTC80273G
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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