Mountain Shadows Community Homes - Oak

LBN: Mountain Shadows Support Group, Inc.
Mountain Shadows Community Homes - Oak is an health care organization with primary practice located at 866 Viking Ln , San Marcos CA 92069-5806. The organization recently has only one registered license in Nursing & Custodial Care Facilities / Intermediate Care Facility, Mentally Retarded, 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
866 Viking Ln San Marcos CA 92069-5806
Phone: (760) 743-3714
Fax: (760) 743-9937
Website:
Map and Directions
Authorized official contact:
Name: Bryson, Lupe
Phone: (760) 743-3714

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Intermediate Care Facility, Mentally Retarded 315P00000X 46989489 California

Profile Details

NPI number 1235254582
LBN Legal business name Mountain Shadows Support Group, Inc.
DBA Doing business as Mountain Shadows Community Homes - Oak
Authorized official Bryson, Lupe
Entity Organization
Organization subpart 1 No
Enumeration date Mar 19th, 2007
Last updated Aug 22nd, 2020 - about 4 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235254582 NPPES
California MEDICAID LTC60744G

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