Organization
SHADOW MOUNTAIN RECOVERY LLC.
Active
Other names
Shadow Mountain Recovery Rio Rancho
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE HOLUB (VP, OPERATIONS)
(925) 389-8591
Entity
Organization
Contact information
Practice address
1550 BRIDGER RD NE, RIO RANCHO, NM 87144-1579
(800) 203-8249
Mailing address
1550 BRIDGER RD NE, RIO RANCHO, NM 87144-1579
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
15453081
—
NM
Enumeration date
07/13/2021
Last updated
07/13/2021
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