<Unavail>

LBN: Mountain Shadows Support Group
<Unavail> is an health care organization with primary practice located at 689 Dane Dr , San Marcos CA 92069-5825. The organization recently has only one registered license in Nursing & Custodial Care Facilities / Intermediate Care Facility, Mentally Retarded, which is considered as the primary health care specialty. Mountain Shadows Support Group can be contacted via phone (760) 743-3714, or through Wilde, Wade via phone (760) 743-3714.

Contact Information

Primary practice address
689 Dane Dr San Marcos CA 92069-5825
Phone: (760) 743-3714
Fax: (760) 736-4173
Website:
Map and Directions
Authorized official contact:
Name: Wilde, Wade
Phone: (760) 743-3714

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Intermediate Care Facility, Mentally Retarded 315P00000X 550003036 California

Profile Details

NPI number 1992107221
LBN Legal business name Mountain Shadows Support Group
DBA Doing business as <Unavail>
Authorized official Wilde, Wade
Entity Organization
Organization subpart 1 No
Enumeration date Sep 18th, 2014
Last updated Mar 23rd, 2016 - about 10 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1992107221 NPPES
California MEDICAID 550003036

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