NPIMap

Organization Active NPI

Mountain Shadows Support Group, Inc

  • Nursing Facility/Intermediate Care Facility
  • Riverside, CA
National Provider Identifier
1922123157
Registry record updated Dec 26, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
46989489 Issued in CA
Legal business name
MOUNTAIN SHADOWS SUPPORT GROUP, INC
Practice address
7989 Halbrook Ter
Riverside, CA 92509-4020
Phone
(760) 743-3714
Fax
(760) 743-9937
NPI assigned
Mar 20, 2007
Last updated
Dec 26, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2007

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 46989489 CA Primary

Addresses

Primary practice location

7989 Halbrook Ter
Riverside, CA 92509-4020

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
LTC80025GMedicaidCA
LTC80025FMedicaidCA

Other names 1

  • Special Kids Homes-Halbrook House Former legal business name

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 1922123157. Details of each certification follow.

  • CCN 05G532 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 05G532

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
MOUNTAIN SHADOWS SPECIAL KIDS HOMES HALBROOK HOUSE
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Aug 1, 1991
Last certification
Oct 7, 2025
Beds
6
Ownership / control type
Private (non-profit)
Facility address
7989 Halbrook Terrace
Riverside, CA 92509

National Provider Directory

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

Other organizations with this tax ID 34

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

View all 34

Locations

7989 Halbrook Ter
Riverside, CA 92509

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": "1198627200000",
    "number": "1922123157",
    "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": "7989 HALBROOK TER",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925094020",
            "telephone_number": "760-743-3714",
            "fax_number": "760-743-9937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN SHADOWS SUPPORT GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2007-12-26",
        "status": "A",
        "authorized_official_last_name": "BRYSON",
        "authorized_official_first_name": "LUPE",
        "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": "CA",
            "license": "46989489",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC80025G",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC80025F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Special Kids Homes-Halbrook House",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.