Organization
MOUNTAIN SHADOWS SUPPORT GROUP
Active
Other names
MOUNTAIN SHADOWS SPECIAL KIDS HOMES-GARTH
Organization subpart
No
Provider details
NPI number
Authorized official
LUPE BRYSON (BUSINESS OFFICE MANAGER)
(760) 743-3714
Entity
Organization
Contact information
Practice address
4287 GARTH ST, JURUPA VALLEY, CA 92509-3316
(760) 743-3714
Mailing address
970 LOS VALLECITOS BLVD, SAN MARCOS, CA 92069-1473
(760) 743-3714
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Enumeration date
04/13/2016
Last updated
04/19/2016
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