Active NPI
Shadow Mountain Management
- Skilled Nursing Facility
- Canon City, CO
National Provider Identifier
1366430910
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 0055
- Legal business name
- SHADOW MOUNTAIN MANAGEMENT
- Practice address
- 1401 Phay Ave
Canon City, CO 81212-2303 - Phone
- (719) 275-8656
- NPI assigned
- Oct 7, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Shelby Townsend
- Title
- Business Office Manager
- Phone
- (719) 275-8656
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 0055 | CO | Primary |
Addresses
Primary practice location
1401 Phay Ave
Canon City, CO 81212-2303
Mailing address
1401 Phay Ave
Canon City, CO 81212-2303
Phone (719) 275-8656
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05653571 | Medicaid | CO | |
| 42337071 | Other | CO | RESPITE PROVIDER NUMBER |
Other names 1
- Hildebrand Care Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100430000687 | CO | Part A Provider - Skilled Nursing Facility | 3678601275 | Practice locations: Canon City, CO |
Skilled nursing facility certification: CCN 065179
- Legal name
- SHADOW MOUNTAIN MANAGEMENT
- Doing business as
- HILDEBRAND CARE CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Oct 18, 1983
- Last certification
- Nov 16, 2023
- Beds
- 75
- Ownership / control type
- Corporation
- Organization structure
- Corporation
- Incorporated
- Nov 1, 1973 in CO
- Enrollment address
- 1401 Phay Ave
Canon City, CO 81212-2303 - Nursing home name
- HILDEBRAND CARE CENTER
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Hildebrand Care Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Oct 18, 1983
- Medicare certification status
- Active
- Certified beds
- 75
- Penalties (3 years)
- 1
National Provider Directory
National Provider Directory- Tax ID family
- Hildbrand Care Ctr
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Respite Care
- Canon City, CO
- NPI 1780198598
Ownership & related parties
All disclosed owners & managing parties 6
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Kimberly Beaton | 5% Or Greater Direct Ownership Interest | Aug 1, 2017 | |
| Shadow Mountain Management | 5% Or Greater Direct Ownership Interest | Nov 1, 1973 | |
| Operational/Managerial Control | Aug 1, 2016 | 90% | |
| Sharon Leonard | 5% Or Greater Direct Ownership Interest | Aug 1, 2017 | |
| Phillip Cory | Corporate Director | Jan 1, 2010 | |
| Robert Hamby | Corporate Director | Jan 1, 2010 | |
| Delwin Lester | Operational/Managerial Control | May 31, 2018 | 100% |
Practitioners & affiliated clinicians
Affiliated clinicians 5
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128643200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1769558400000",
"number": "1366430910",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1401 PHAY AVE",
"city": "CANON CITY",
"state": "CO",
"postal_code": "812122303",
"telephone_number": "719-275-8656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 PHAY AVE",
"city": "CANON CITY",
"state": "CO",
"postal_code": "812122303",
"telephone_number": "719-275-8656"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SHADOW MOUNTAIN MANAGEMENT",
"organizational_subpart": "NO",
"enumeration_date": "2005-10-07",
"last_updated": "2026-01-28",
"certification_date": "2026-01-28",
"status": "A",
"authorized_official_last_name": "TOWNSEND",
"authorized_official_first_name": "SHELBY",
"authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
"authorized_official_telephone_number": "719-275-8656"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "CO",
"license": "0055",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "05653571",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RESPITE PROVIDER NUMBER",
"identifier": "42337071",
"state": "CO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Hildebrand Care Center",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Hildebrand Care Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Canon City, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.