Organization
MOUNTAIN SHADOWS SUPPORT GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WADE WILDE (EXECUTIVE DIRECTOR)
(760) 743-3714
Entity
Organization
Contact information
Practice address
4880 BROOKHILL TER, JURUPA VALLEY, CA 92509-4047
(760) 743-3714
Mailing address
970 LOS VALLECITOS BLVD, SUITE 240, SAN MARCOS, CA 92069-1473
(760) 743-3714
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
—
Other
Enumeration date
02/23/2015
Last updated
02/23/2015
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