Organization
SHADOW MOUNTAIN LLC.
Active
Other names
Shadow Mountain Recovery, Taos
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE HOLUB (VICE PRESIDENT)
(925) 389-8591
Entity
Organization
Contact information
Practice address
250 SHADOW MOUNTAIN RD., TAOS, NM 87571
(575) 751-4851
Mailing address
PO BOX 830525, DEPARTMENT # SF 57, BIRMINGHAM, AL 35283-0525
(931) 451-7757
(931) 933-7762
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
STATE WAIVER
NM
Other
Enumeration date
04/10/2014
Last updated
05/10/2017
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