NPIMap

Organization Active NPI

Mountain Shadows Support Group, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Escondido, CA
National Provider Identifier
1972628121
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
46989489 Issued in CA
Legal business name
MOUNTAIN SHADOWS SUPPORT GROUP, INC.
Practice address
2067 W El Norte Pkwy
Escondido, CA 92026-1810
Phone
(760) 743-3714
Fax
(760) 743-9937
NPI assigned
Mar 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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
Intellectual Disabilities Intermediate Care Facility 315P00000X 46989489 CA Primary

Addresses

Primary practice location

2067 W El Norte Pkwy
Escondido, CA 92026-1810

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
LTC60208HMedicaidCA

Other names 1

  • Mountain Shadows Community Homes-Tangelo Doing business as

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

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": "1598054400000",
    "number": "1972628121",
    "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": "2067 W EL NORTE PKWY",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920261810",
            "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": "2020-08-22",
        "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": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": "46989489",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC60208H",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain Shadows Community Homes-Tangelo",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Escondido, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.