MOUNTAIN SHADOWS SUPPORT GROUP, INC. (NPI# 1235254582) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235254582 |
| Entity Type | Organization |
| Organization Name | MOUNTAIN SHADOWS SUPPORT GROUP, INC. |
| Other Organization Name | MOUNTAIN SHADOWS COMMUNITY HOMES - OAK |
| Practice Address |
866 Viking Ln San Marcos CA 92069-5806 |
| Mailing Address |
2067 W El Norte Pkwy Escondido CA 92026-1810 |
| Practice Telephone | 7607433714 |
| Practice Fax Number | 7607439937 |
| Mailing Telephone | 7607433714 |
| Mailing Fax Number | 7607439937 |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | LUPE BRYSON (BUSINESS OFFICE MANAGER) |
| Authorized Official Telephone | 7607433714 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | 46989489 | CA | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | LTC60744G | 05 |
| Other Name | Type Code |
|---|---|
| Mountain Shadows Community Homes - Oak | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003931262 | Mountain Shadows Support Group, Inc. | Intermediate Care Facility, Mentally Retarded | 600 Rose Ct, San Marcos, CA 92069-5828 | 2007-03-20 |
| 1750406070 | Mountain Shadows Support Group, Inc. | Nursing Facility/Intermediate Care Facility | 4680 Glen St, Riverside, CA 92509-3005 | 2007-03-20 |
| 1407971633 | Mountain Shadows Support Group, Inc. | Nursing Facility/Intermediate Care Facility | 7456 River Glen Dr, Riverside, CA 92509-3451 | 2007-03-20 |
| 1215061767 | Mountain Shadows Support Group, Inc. | Nursing Facility/Intermediate Care Facility | 25654 Sierra Leone Ct, Moreno Valley, CA 92551-2100 | 2007-03-15 |
| 1063561991 | Mountain Shadows Support Group, Inc. | Nursing Facility/Intermediate Care Facility | 27344 Darlene Dr, Moreno Valley, CA 92555-2126 | 2007-01-09 |
| 1396860540 | Mountain Shadows Support Group, Inc. | Intermediate Care Facility, Mentally Retarded | 2067 W El Norte Pkwy, Escondido, CA 92026-1810 | 2007-03-20 |
| 1972628121 | Mountain Shadows Support Group, Inc. | Intermediate Care Facility, Mentally Retarded | 2067 W El Norte Pkwy, Escondido, CA 92026-1810 | 2007-03-20 |
| 1922123181 | Mountain Shadows Support Group, Inc. | Intermediate Care Facility, Mentally Retarded | 2067 W El Norte Pkwy, Escondido, CA 92026-1810 | 2007-03-20 |
| 1710002951 | Mountain Shadows Support Group, Inc. | Intermediate Care Facility, Mentally Retarded | 2067 W El Norte Pkwy, Escondido, CA 92026-1810 | 2007-03-20 |
| 1720103971 | Mountain Shadows Support Group, Inc. | Intermediate Care Facility, Mentally Retarded | 2067 W El Norte Pkwy, Escondido, CA 92026-1810 | 2007-03-20 |
| Street Address |
866 VIKING LN |
| City | SAN MARCOS |
| State | CA |
| Zip Code | 92069-5806 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396364071 | Doreatha Yvonne Gandy-edmundson | Social Worker | 112 North Centre City Parkway, Unit 103, San Marcos, CA 92069 | 2020-04-13 |
| 1588150296 | Martha Gallo | Adult Companion | 1227 Armorlite Dr Apt 102, San Marcos, CA 92069 | 2018-07-05 |
| 1508357765 | Jensen Moore | Chiropractor | 370 Mulberry Dr Ste C, San Marcos, CA 92069 | 2018-05-23 |
| 1457870156 | Brandie Janette Limon-nava | Counselor | 751 Rancheros Dr Suite 5, San Marcos, CA 92069 | 2017-09-13 |
| 1336436872 | Vivek Solanki | Dentist | 197 Woodland Pkwy #100, Mission Hills Family Dental, San Marcos, CA 92069 | 2011-07-05 |
| 1558689448 | Jessie Janette Hiatt | Marriage & Family Therapist | 330 Rancheros Dr Ste 218, San Marcos, CA 92069 | 2010-05-17 |
| 1407174113 | Daniel Reinke | Counselor | 1560 Capalina Road, San Marcos, CA 92069 | 2010-05-06 |
| 1902130842 | Tiara Christine Esani | Physician Assistant | 277 Rancheros Drive, Suite 100, San Marcos, CA 92069 | 2009-09-24 |
| 1124220926 | Garfield Beach Cvs, L.L.C. | Durable Medical Equipment & Medical Supplies | 997 Woodland Pkwy, San Marcos, CA 92069 | 2007-06-04 |
| 1275755845 | Davoudi Dds Inc. | Dentist | 979 Woodland Parkway, Suite 100, San Marcos, CA 92069 | 2007-05-03 |
| Find all providers in zip 92069 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992107221 | Mountain Shadows Support Group | Intermediate Care Facility, Mentally Retarded | 689 Dane Dr, San Marcos, CA 92069-5825 | 2014-09-18 |
| 1003931262 | Mountain Shadows Support Group, Inc. | Intermediate Care Facility, Mentally Retarded | 600 Rose Ct, San Marcos, CA 92069-5828 | 2007-03-20 |
| 1962541177 | Villadel Inc | Intermediate Care Facility, Mentally Retarded | 841 Saint Sava Pl, San Marcos, CA 92069-3591 | 2007-02-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215545538 | Vine Valley Homes II | Intermediate Care Facility, Mentally Retarded | 8400 Bellingham Ave, Sun Valley, CA 91352-3803 | 2020-07-22 |
| 1841811791 | Young Walker Inc. | Intermediate Care Facility, Mentally Retarded | 14 Deer Ct, Sacramento, CA 95823-4402 | 2020-05-01 |
| 1003441155 | Sunrise Premier Homes LLC | Intermediate Care Facility, Mentally Retarded | 13831 Ruther Ave, Paramount, CA 90723-2662 | 2020-03-10 |
| 1649805912 | Jingma Inc | Intermediate Care Facility, Mentally Retarded | 34909 Osprey Dr, Union City, CA 94587-4618 | 2020-03-07 |
| 1124661699 | Rscr California, Inc. | Intermediate Care Facility, Mentally Retarded | 581 S Gilmar St, Anaheim, CA 92802-1306 | 2019-10-28 |
| 1467095935 | Rscr California, Inc. | Intermediate Care Facility, Mentally Retarded | 1592 W Lorane Way, Anaheim, CA 92802-3930 | 2019-10-28 |
| 1992348460 | Rscr California, Inc. | Intermediate Care Facility, Mentally Retarded | 5940 Los Angeles Way, Buena Park, CA 90620-2723 | 2019-10-28 |
| 1578106043 | Rscr California, Inc. | Intermediate Care Facility, Mentally Retarded | 2918 E Greenhedge Ave, Anaheim, CA 92806-3804 | 2019-10-28 |
| 1790328680 | Rscr California, Inc. | Intermediate Care Facility, Mentally Retarded | 2143 W Fir Ave, Anaheim, CA 92801-3436 | 2019-10-23 |
| 1356984249 | Rscr California, Inc. | Intermediate Care Facility, Mentally Retarded | 6540 Christine Cir, Buena Park, CA 90620-4511 | 2019-10-23 |
| Find all providers with the same taxonomy | ||||
| City | SAN MARCOS |
| Zip Code | 92069 |
Please comment or provide details below to improve the information on MOUNTAIN SHADOWS SUPPORT GROUP, INC..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.