Organization
SHADOW MOUNTAIN LLC.
Active
Other names
Shadow Mountain Recovery, Colorado Springs
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JACKIE HOLUB (VICE PRESIDENT)
(925) 389-8591
Entity
Organization
Contact information
Practice address
1155 KELLY JOHNSON BLVD, SUITE 201, COLORADO SPRINGS, CO 80920-3932
(719) 418-3737
Mailing address
PO BOX 830525, DEPARTMENT # SF 58, BIRMINGHAM, AL 35283-0525
(931) 451-7757
(931) 933-7762
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
1746-01
CO
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
11/14/2013
Last updated
02/27/2017
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