Organization · Type 2 NPI

Mountain Shadows Support Group, Inc.

Nursing Facility/Intermediate Care Facility · Riverside, CA

NPI number 1750406070 Active

Practice location

4680 Glen St
Riverside, CA 92509-3005

Call (760) 743-3714 Map

Fax (760) 743-9937

Mailing address

2067 W El Norte Pkwy
Escondido, CA 92026-1810

Specialties and licenses

Taxonomy	Code	License
Nursing Facility/Intermediate Care Facility Primary	313M00000X	46989489 (CA)

Nursing Facility/Intermediate Care Facility: An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical conditi…

Other nursing facility/intermediate care facility providers in Riverside

See all in Riverside →

NPI record

NPI: 1750406070
Entity type: Organization (Type 2)
Issued: Mar 20, 2007
Last updated: Feb 15, 2008
Status: Active
Subpart: Yes of Mountain Shadows Support Group.

Other names

<unavail>
Special Kids Homes-Glen House · doing business as

Authorized official

Lupe Bryson
Business Office Manager
(760) 743-3714

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

Is this your record? How to update it.

About NPI 1750406070

Mountain Shadows Support Group, Inc.'s National Provider Identifier is 1750406070, issued on Mar 20, 2007. The primary taxonomy on file is Nursing Facility/Intermediate Care Facility (313M00000X), and the practice location is in Riverside, CA. The record was last updated on Feb 15, 2008.