Organization
SHADOW MOUNTAIN LLC.
Active
Other names
Shadow Mountain Recovery, University Park
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE HOLUB (VICE PRESIDENT)
(925) 389-8591
Entity
Organization
Contact information
Practice address
2102 UNIVERSITY PARK BLVD., COLORADO SPRINGS, CO 80918
(719) 266-8876
Mailing address
PO BOX 830525, DPEARTMENT # SF 59, BIRMINGHAM, AL 35283-0525
(931) 451-7757
(931) 933-7762
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
11/13/2015
Last updated
04/27/2017
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