Shadow Hills Recovery, Inc

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

SHADOW HILLS RECOVERY, INC

Practice address

10941 Meseta Ave
Sunland, CA 91040-1376

Phone

(661) 466-6658

NPI assigned

Jul 23, 2021

Organization subpart

No

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

Authorized official

Name

Mr. Edrick Theo Banks, CADC-I

Title

Program Director

Phone

(661) 466-6658

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1626998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626998400000",
    "number": "1548833734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10941 MESETA AVE",
            "city": "SUNLAND",
            "state": "CA",
            "postal_code": "910401376",
            "telephone_number": "661-466-6658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10941 MESETA AVE",
            "city": "SUNLAND",
            "state": "CA",
            "postal_code": "910401376",
            "telephone_number": "661-466-6658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADOW HILLS RECOVERY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-23",
        "last_updated": "2021-07-23",
        "certification_date": "2021-07-23",
        "status": "A",
        "authorized_official_last_name": "BANKS",
        "authorized_official_first_name": "EDRICK",
        "authorized_official_middle_name": "THEO",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "661-466-6658",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CADC-I"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Substance Abuse Rehabilitation Facility in Sunland, CA
• Providers in Sunland, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2021; 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.