Shadow Mountain LLC.
Organization Active NPI Substance Abuse Rehabilitation Facility · Albuquerque, NM
NPI 1760621007 · NPPES record last updated Oct 28, 2015
Key facts
- NPI
- 1760621007
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Abuse Rehabilitation Facility 324500000X
- Legal business name
- SHADOW MOUNTAIN LLC.
- Practice address
- 5400 Gibson Blvd. S. E
3Rd Floor
Albuquerque, NM 87109 - Phone
- (505) 296-8184
- NPI assigned
- Feb 10, 2009
- Organization subpart
- No
Authorized official
- Name
- Jackie Holub
- Title
- Managing Director
- Phone
- (925) 389-8591
Corporate family (same tax ID) 11
National Provider Directory
- Tax ID family
- Shadow Mountain LLC
Locations
5400 Gibson Blvd SE
Ste 3
Albuquerque, NM 87108
Phone (505) 842-5550
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Abuse Rehabilitation Facility | 324500000X | Yes |
Addresses
Primary practice location
5400 Gibson Blvd. S. E
3Rd Floor
Albuquerque, NM 87109
Mailing address
5400 Gibson Blvd. S.E
3Rd Floor
Albuquerque, NM 87109
Phone (505) 867-0214
Other names
- Shadow Mountain Recovery, Albuquerque
Other providers in Albuquerque, NM
- Sfaba NM LLC
- Tyler Ray Shackelford
- Olivia Sumia Shadid
- Neal Shadoff
- Shadow Mountain Health LLC.
- Shadow Mountain Recovery LLC.
- Darren M Shafer
- Skylar Kane Shafer
- Susan L Shafer
- Diedre Ann Shaffer
All providers in Albuquerque, NM · Substance Abuse Rehabilitation Facility in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 28, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.