Organization
SHADOW MOUNTAIN LLC.
Active
Organization
SHADOW MOUNTAIN LLC.
Active
Other names
Shadow Mountain Detox Hospital, St. George
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE HOLUB (VICE PRESIDENT)
(925) 389-8591
Entity
Organization
Contact information
Practice address
120 W. 1470 SOUTH, BUILDING B, ST. GEORGE, UT 84770
(435) 272-0220
(435) 272-0222
Mailing address
PO BOX 830525, DEPARTMENT # SF 59, BIRMINGHAM, AL 35283-0525
(931) 451-7757
(931) 933-7762
Taxonomy
Speciality
Code
Description
License number
State
284300000X
Special Hospital
Primary
—
—
Other
Enumeration date
07/10/2014
Last updated
04/26/2017
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