NPIMap

Organization Active NPI

Mountain Shadows Support Group

  • Nursing Facility/Intermediate Care Facility
  • Jurupa Valley, CA
National Provider Identifier
1326430711
Registry record updated Feb 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
Legal business name
MOUNTAIN SHADOWS SUPPORT GROUP
Practice address
4880 Brookhill Ter
Jurupa Valley, CA 92509-4047
Phone
(760) 743-3714
NPI assigned
Feb 23, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2015

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

Authorized official

Name
Wade Wilde
Title
Executive Director
Phone
(760) 743-3714

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X Primary

Addresses

Primary practice location

4880 Brookhill Ter
Jurupa Valley, CA 92509-4047

Mailing address

970 Los Vallecitos Blvd
Suite 240
San Marcos, CA 92069-1473
Phone (760) 743-3714

National Provider Directory

National Provider Directory
Tax ID family
Mountain Shadows Support Group35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

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

View all 34

Locations

4880 Brookhill Ter
Jurupa Valley, CA 92509

NPI Registry JSON

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

{
    "created_epoch": "1424649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424649600000",
    "number": "1326430711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "970 LOS VALLECITOS BLVD",
            "address_2": "SUITE 240",
            "city": "SAN MARCOS",
            "state": "CA",
            "postal_code": "920691473",
            "telephone_number": "760-743-3714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4880 BROOKHILL TER",
            "city": "JURUPA VALLEY",
            "state": "CA",
            "postal_code": "925094047",
            "telephone_number": "760-743-3714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN SHADOWS SUPPORT GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-23",
        "last_updated": "2015-02-23",
        "status": "A",
        "authorized_official_last_name": "WILDE",
        "authorized_official_first_name": "WADE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "760-743-3714"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jurupa Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2015; 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.