Special Kids Homes-Maverick House
LBN: Mountain Shadows Support Group, Inc
Special Kids Homes-Maverick House is an health care organization with primary practice located at 8163 Laurel Park Cir , Riverside CA 92509-4075. The organization recently has only one registered license in Nursing & Custodial Care Facilities / Nursing Facility/Intermediate Care Facility, which is considered as the primary health care specialty.
Mountain Shadows Support Group, Inc can be contacted via phone (760) 743-3714, or through Bryson, Lupe via phone (760) 743-3714.
Contact Information
Primary practice address
8163 Laurel Park Cir
Riverside CA 92509-4075
Phone: (760) 743-3714
Fax: (760) 736-4173
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Nursing & Custodial Care Facilities / Nursing Facility/Intermediate Care Facility | 313M00000X | 46989489 | California |
Profile Details
| NPI number | 1053436287 |
|---|---|
| LBN Legal business name | Mountain Shadows Support Group, Inc |
| DBA Doing business as | Special Kids Homes-Maverick House |
| Authorized official | Bryson, Lupe |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Mar 20th, 2007 |
| Last updated | Sep 9th, 2010 - about 14 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1053436287 | NPPES |
| California | MEDICAID | LTC80083G | |
| California | MEDICAID | LTC80083F |
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