Organization
MOUNTAIN SHADOWS SUPPORT GROUP, INC
Active
Other names
Special Kids Homes-Maggie Marsh
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LUPE BRYSON (BUSINESS OFFICE MANAGER)
(760) 743-3714
Entity
Organization
Contact information
Practice address
MAGGIE MARSH, 10467 MORNING RIDGE DR., MORENO VALLEY, CA 92557
(760) 743-3714
(760) 743-9937
Mailing address
MAGGIE MARSH, 2067 W. EL NORTE PKWY, ESCONDIDO, CA 92026
(760) 743-3714
(760) 743-9937
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
46989489
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC80273F
—
CA
05
—
LTC80273G
—
CA
Enumeration date
03/19/2007
Last updated
12/26/2007
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