Organization
MOUNTAIN SHADOWS SUPPORT GROUP, INC
Active
Other names
Special Kids Homes-Baker House
Organization subpart
No
Provider details
NPI number
Authorized official
LUPE BRYSON (BUSINESS OFFICE MANAGER)
(760) 743-3714
Entity
Organization
Contact information
Practice address
4840 FAIRHILL PLACE, RIVERSIDE, CA 92026
(760) 743-3714
(760) 743-9937
Mailing address
2067 W EL NORTE PKWY, ESCONDIDO, CA 92026-1810
(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
—
LTC80158F
—
CA
05
—
LTC80158G
—
CA
Enumeration date
03/20/2007
Last updated
12/26/2007
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