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Shadow Mountain LLC.

Organization Active NPI Substance Abuse Rehabilitation Facility · Colorado Springs, CO

NPI 1801226709 · NPPES record last updated Feb 27, 2017

Key facts

NPI
1801226709
Entity type
Organization (NPI type 2)
Primary specialty
Substance Abuse Rehabilitation Facility 324500000X
Legal business name
SHADOW MOUNTAIN LLC.
Practice address
1155 Kelly Johnson Blvd
Suite 201
Colorado Springs, CO 80920-3932
Phone
(719) 418-3737
NPI assigned
Nov 14, 2013
Organization subpart
No

Authorized official

Name
Ms. Jackie Holub
Title
Vice President
Phone
(925) 389-8591

Corporate family (same tax ID) 11

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

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

  • Laurence Freedom, M.E, CACIII, LPC Addiction (Substance Use Disorder) Counselor · Colorado Springs, CO · NPI 1003233404
    NPD (past)

National Provider Directory

Tax ID family
Shadow Mountain LLC (12 organizations share this tax ID)

Locations

1155 Kelly Johnson Blvd
Ste 201
Colorado Springs, CO 80920
Phone (719) 418-3737

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 1746-01 CO
Substance Abuse Rehabilitation Facility 324500000X Yes

Addresses

Primary practice location

1155 Kelly Johnson Blvd
Suite 201
Colorado Springs, CO 80920-3932

Mailing address

PO Box 830525
Department # SF 58
Birmingham, AL 35283-0525
Phone (931) 451-7757

Other names

  • Shadow Mountain Recovery, Colorado Springs Doing business as

Other providers in Colorado Springs, CO

All providers in Colorado Springs, CO · Substance Abuse Rehabilitation Facility in Colorado

Sources for this page

Verify at the official NPI Registry.