NPIMap

Organization Active NPI

Mountain Shadows Support Group

Doing business as Mtn. Shadows Community Homes - Jacaranda

  • Intellectual Disabilities Intermediate Care Facility
  • Escondido, CA
National Provider Identifier
1346365590
Registry record updated Jul 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
46989489 Issued in CA
Legal business name
MOUNTAIN SHADOWS SUPPORT GROUP
Doing business as
Mtn. Shadows Community Homes - Jacaranda
Practice address
2067 W El Norte Pkwy
Escondido, CA 92026-1810
Phone
(760) 743-3714
Fax
(760) 743-9937
NPI assigned
Mar 20, 2007
Last updated
Jul 24, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
MOUNTAIN SHADOWS SUPPORT GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 24, 2019

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

Authorized official

Name
Guadalupe Bryson
Title
Business Office Manager
Phone
(760) 743-3714

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X NU
Intellectual Disabilities Intermediate Care Facility 315P00000X 46989489 CA Primary

Addresses

Primary practice location

2067 W El Norte Pkwy
Escondido, CA 92026-1810

Mailing address

2067 W El Norte Pkwy
Escondido, CA 92026-1810
Phone (760) 743-3714

Other identifiers 1

IdentifierTypeStateIssuer
LTC60153IMedicaidCA

Other names 1

  • Mtn. Shadows Community Homes - Jacaranda Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346365590. Details of each certification follow.

  • CCN 05G486 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 05G486

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
MTN SHADOWS COMM HOMES - JACARANDA
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Mar 1, 1991
Last certification
Apr 16, 2025
Beds
6
Ownership / control type
Private (non-profit)
Most recent change of ownership
Oct 1, 2002
Facility address
2067 W El Norte Pky
Escondido, CA 92026

National Provider Directory

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

Other organizations with this tax ID 34

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

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563926400000",
    "number": "1346365590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2067 W EL NORTE PKWY",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920261810",
            "telephone_number": "760-743-3714",
            "fax_number": "760-743-9937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2067 W EL NORTE PKWY",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920261810",
            "telephone_number": "760-743-3714",
            "fax_number": "760-743-9937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN SHADOWS SUPPORT GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOUNTAIN SHADOWS SUPPORT GROUP",
        "enumeration_date": "2007-03-20",
        "last_updated": "2019-07-24",
        "status": "A",
        "authorized_official_last_name": "BRYSON",
        "authorized_official_first_name": "GUADALUPE",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "760-743-3714"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": "46989489",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC60153I",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mtn. Shadows Community Homes - Jacaranda",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mtn. Shadows Community Homes - Jacaranda",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Escondido, CA

Sources for this page

Verify at the official NPI Registry.