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Organization
MOUNTAIN SHADOWS SUPPORT GROUP
Active
Organization
MOUNTAIN SHADOWS SUPPORT GROUP
Active
Parent organization
MOUNTAIN SHADOWS SUPPORT GROUP
Other names
Mtn. Shadows Community Homes - Jacaranda
Organization subpart
Yes
Provider details
NPI number
Legal business name
MOUNTAIN SHADOWS SUPPORT GROUP
Authorized official
GUADALUPE BRYSON (BUSINESS OFFICE MANAGER)
(760) 743-3714
Entity
Organization
Contact information
Practice address
2067 W EL NORTE PKWY, ESCONDIDO, CA 92026-1810
(760) 743-3714
(760) 743-9937
Mailing address
2067 W EL NORTE PKWY, ESCONDIDO, CA 92026-1810
(760) 743-3714
(760) 743-9937
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
—
—
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
46989489
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC60153I
—
CA
Enumeration date
03/20/2007
Last updated
07/24/2019
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