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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