SHADOW MOUNTAIN LLC. (NPI# 1831505874) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831505874 |
| Entity Type | Organization |
| Organization Name | SHADOW MOUNTAIN LLC. |
| Other Organization Name | SHADOW MOUNTAIN DETOX HOSPITAL, ST. GEORGE |
| Practice Address |
120 W. 1470 South Building B St. George UT 84770 |
| Mailing Address |
Po Box 830525 Department # Sf 59 Birmingham AL 35283-0525 |
| Practice Telephone | 4352720220 |
| Practice Fax Number | 4352720222 |
| Mailing Telephone | 9314517757 |
| Mailing Fax Number | 9319337762 |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2017-04-26 |
| Authorized Official Name | JACKIE HOLUB (VICE PRESIDENT) |
| Authorized Official Telephone | 9253898591 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 284300000X | Special Hospital | Hospitals |
| Other Name | Type Code |
|---|---|
| Shadow Mountain Detox Hospital, St. George | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164896197 | Shadow Mountain LLC. | Substance Abuse Rehabilitation Facility | 2102 University Park Blvd., Colorado Springs, CO 80918 | 2015-11-13 |
| 1699182410 | Shadow Mountain LLC. | Clinic/Center | 8200 E. Belleview Blvd., Suite 400e, Greenwood Village, CO 80111 | 2014-07-14 |
| 1154733558 | Shadow Mountain LLC. | Substance Abuse Rehabilitation Facility | 5250 Pikes Peak Highway, Cascade, CO 80809 | 2014-05-20 |
| 1295154888 | Shadow Mountain LLC. | Substance Abuse Rehabilitation Facility | 250 Shadow Mountain Rd., Taos, NM 87571 | 2014-04-10 |
| 1760621007 | Shadow Mountain LLC. | Substance Abuse Rehabilitation Facility | 5400 Gibson Blvd. S. E, 3rd Floor, Albuquerque, NM 87109 | 2009-02-10 |
| 1437521507 | Shadow Mountain LLC. | Substance Abuse Rehabilitation Facility | 5400 Gibson Blvd Se, Third Floor, Suite A, Albuquerque, NM 87108-4729 | 2015-10-28 |
| 1801226709 | Shadow Mountain LLC. | Community/Behavioral Health | 1155 Kelly Johnson Blvd, Suite 201, Colorado Springs, CO 80920-3932 | 2013-11-14 |
| Street Address |
120 W. 1470 SOUTH BUILDING B |
| City | ST. GEORGE |
| State | UT |
| Zip Code | 84770 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740808500 | Redstone Reference Laboratories Inc | Clinical Medical Laboratory | 556 N Dixie Drive, Suite 2, St George, UT 84770 | 2020-07-08 |
| 1033776315 | Ecko Ashmore | Marriage & Family Therapist | 1173 S. 250 W. Bld 1 Ste 208, St. George, UT 84770 | 2019-05-22 |
| 1740844679 | Amy Darragh | Behavior Technician | 249 E Tabernacle St, Ste 100, St George, UT 84770 | 2019-04-25 |
| 1124598198 | Loren Kyle Gulbranson | Internal Medicine | Dixie Regional Medical Center, 515 South, 300 East, Saint George, UT 84770 | 2018-12-03 |
| 1487150728 | Sound Sleep Medical LLC | Durable Medical Equipment & Medical Supplies | 640 East 700 South Building 2, St. George, UT 84770 | 2018-04-04 |
| 1588162911 | Desert Edge Medical | Family Medicine | 1664 S Dixie Dr Ste D201, St George, UT 84770 | 2018-01-31 |
| 1568981314 | Jeffrey Joseph Peterson | Behavior Technician | 162 N 400 E Ste A-105, St. George, UT 84770 | 2017-09-13 |
| 1992242549 | Zachary Carey | Specialist/Technologist | 1115 W Diamond Valley Dr, Saint George, UT 84770 | 2017-01-20 |
| 1669920427 | Charles Taylor Church | Technician, Other | 474 West 200 East, St. George, UT 84770 | 2016-09-21 |
| 1952755480 | Hollystic Hideaway | Voluntary or Charitable | 1418 W Sunset Blvd. # 2, Saint George, UT 84770 | 2016-04-21 |
| Find all providers in zip 84770 | ||||
| Taxonomy Code | 284300000X |
| Grouping | Hospitals |
| Classification | Special Hospital |
| A designation by the AHA of a hospital whose primary function of the institution is to provide diagnostic and treatment services for patients who have specified medical conditions, both surgical and nonsurgical. |
| Notes: Source: AHA Guide, Registration section, p. A5. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093189839 | St. George Detox Center LLC | Special Hospital | 120 W 1470 S Bldg B, St George, UT 84770-6798 | 2015-11-17 |
| 1063754893 | Trenton Lyle Neal | Special Hospital | 308 W 7200 S, Midvale, UT 84047-1041 | 2013-03-19 |
| 1124208343 | Gateway Aestheetic Institute& Laser Center | Special Hospital | 440 W 200 S Ste 250, Salt Lake City, UT 84101-1462 | 2007-11-05 |
| 1649470113 | New Life Centers | Special Hospital | 1255 E 3900 S Ste 300, Salt Lake City, UT 84124-1389 | 2007-07-23 |
| 1629411020 | Valerie Price | Special Hospital | 9414 S 1335 E, Sandy, UT 84092-2947 | 2013-04-16 |
| 1780926592 | Deborah Deann Rowley | Special Hospital | 308 W 7200 S, Midvale, UT 84047-1041 | 2013-03-19 |
| 1215294228 | Hyrum John Kerbs | Special Hospital | 5848 Fashion Blvd, Murray, UT 84107-6121 | 2012-04-13 |
| 1023306297 | Slc Va Medical Center | Special Hospital | 500 Foothill Drive, Salt Lake City, UT 84148 | 2011-07-21 |
| 1801181631 | University of Utah | Special Hospital | 175 N Medical Dr, Salt Lake City, UT 84132-0001 | 2011-06-09 |
| 1104075092 | Victoria Serpico | Special Hospital | 1950 Circle of Hope, Suite Number 6500, Salt Lake City, UT 84112 | 2008-09-16 |
| Find all providers with the same taxonomy | ||||
| City | ST. GEORGE |
| Zip Code | 84770 |
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| 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.