NPIMap

Organization Active NPI

Shadow Mountain LLC.

Doing business as Shadow Mountain Recovery, University Park

  • Substance Abuse Rehabilitation Facility
  • Colorado Springs, CO
National Provider Identifier
1164896197
Registry record updated Apr 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
SHADOW MOUNTAIN LLC.
Doing business as
Shadow Mountain Recovery, University Park
Practice address
2102 University Park Blvd.
Colorado Springs, CO 80918
Phone
(719) 266-8876
NPI assigned
Nov 13, 2015
Last updated
Apr 27, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jackie Holub
Title
Vice President
Phone
(925) 389-8591

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

2102 University Park Blvd.
Colorado Springs, CO 80918

Mailing address

PO Box 830525
Dpeartment # SF 59
Birmingham, AL 35283-0525
Phone (931) 451-7757

Other names 1

  • Shadow Mountain Recovery, University Park Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Shadow Mountain LLC12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1447372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493251200000",
    "number": "1164896197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 830525",
            "address_2": "DPEARTMENT # SF 59",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352830525",
            "telephone_number": "931-451-7757",
            "fax_number": "931-933-7762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2102 UNIVERSITY PARK BLVD.",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "80918",
            "telephone_number": "719-266-8876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADOW MOUNTAIN LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-13",
        "last_updated": "2017-04-27",
        "status": "A",
        "authorized_official_last_name": "HOLUB",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "925-389-8591"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shadow Mountain Recovery, University Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.