Special Kids Homes-Glen House

LBN: Mountain Shadows Support Group, Inc.
Special Kids Homes-Glen House is an health care organization with primary practice located at 4680 Glen St , Riverside CA 92509-3005. 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
4680 Glen St Riverside CA 92509-3005
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 / Nursing Facility/Intermediate Care Facility 313M00000X 46989489 California

Profile Details

NPI number 1750406070
LBN Legal business name Mountain Shadows Support Group, Inc.
DBA Doing business as Special Kids Homes-Glen House
Authorized official Bryson, Lupe
Entity Organization
Organization subpart 1 Yes
Enumeration date Mar 20th, 2007
Last updated Feb 15th, 2008 - about 16 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 1750406070 NPPES
California MEDICAID LTC80008G
California MEDICAID LTC80008H

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