NPIMap

Organization Active NPI

Mountain Shadows Support Group

Doing business as Mountain Shadows Special Kids Homes-Joshua

  • Nursing Facility/Intermediate Care Facility
  • Jurupa Valley, CA
National Provider Identifier
1932563194
Registry record updated May 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
Legal business name
MOUNTAIN SHADOWS SUPPORT GROUP
Doing business as
Mountain Shadows Special Kids Homes-Joshua
Practice address
7719 Joshua Rd.
Jurupa Valley, CA 92509-3317
Phone
(760) 743-3714
NPI assigned
Apr 13, 2016
Last updated
May 6, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2016

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 CA Primary

Addresses

Primary practice location

7719 Joshua Rd.
Jurupa Valley, CA 92509-3317

Mailing address

970 Los Vallecitos Blvd
Suite 240
San Marcos, CA 92069-1473
Phone (760) 743-3714

Other names 1

  • MOUNTAIN SHADOWS SPECIAL KIDS HOMES-JOSHUA Doing business as

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 1932563194. Details of each certification follow.

  • CCN 55G757 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G757

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 - JOSHUA
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Oct 16, 2017
Last certification
Jul 30, 2025
Beds
6
Ownership / control type
Private (non-profit)
Facility address
7719 Joshua Road
Jurupa Valley, 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

7719 Joshua St
Jurupa Valley, CA 92509

NPI Registry JSON

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

{
    "created_epoch": "1460505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462492800000",
    "number": "1932563194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "970 LOS VALLECITOS BLVD",
            "address_2": "SUITE 240",
            "city": "SAN MARCOS",
            "state": "CA",
            "postal_code": "920691473",
            "telephone_number": "760-743-3714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7719 JOSHUA RD.",
            "city": "JURUPA VALLEY",
            "state": "CA",
            "postal_code": "925093317",
            "telephone_number": "760-743-3714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN SHADOWS SUPPORT GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-13",
        "last_updated": "2016-05-06",
        "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": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MOUNTAIN SHADOWS SPECIAL KIDS HOMES-JOSHUA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jurupa Valley, CA

Sources for this page

Verify at the official NPI Registry.