NPIMap

Organization Active NPI

Mountain Shadows Support Group

  • Intellectual Disabilities Intermediate Care Facility
  • San Marcos, CA
National Provider Identifier
1992107221
Registry record updated Mar 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
550003036 Issued in CA
Legal business name
MOUNTAIN SHADOWS SUPPORT GROUP
Doing business as
Mtn. Shadows Community Homes- Fig House
Practice address
689 Dane Dr
San Marcos, CA 92069-5825
Phone
(760) 743-3714
Fax
(760) 736-4173
NPI assigned
Sep 18, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2016

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

Authorized official

Name
Wade Wilde
Title
Executive Director
Phone
(760) 743-3714

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 550003036 CA Primary

Addresses

Primary practice location

689 Dane Dr
San Marcos, CA 92069-5825

Mailing address

970 Los Vallecitos Blvd Ste 240
San Marcos, CA 92069-1475
Phone (760) 743-3714

Other identifiers 1

IdentifierTypeStateIssuer
550003036MedicaidCA

Other names 1

  • Mtn. Shadows Community Homes- Fig House Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G731

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
MTN SHADOWS COMM HOMES - FIG
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Sep 24, 2015
Last certification
Dec 3, 2025
Beds
6
Ownership / control type
Private (non-profit)
Facility address
689 Dane Dr
San Marcos, CA 92069

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

970 Los Vallecitos Blvd
Ste 240
San Marcos, CA 92069

NPI Registry JSON

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

{
    "created_epoch": "1410998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458691200000",
    "number": "1992107221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "970 LOS VALLECITOS BLVD STE 240",
            "city": "SAN MARCOS",
            "state": "CA",
            "postal_code": "920691475",
            "telephone_number": "760-743-3714",
            "fax_number": "760-736-4173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "689 DANE DR",
            "city": "SAN MARCOS",
            "state": "CA",
            "postal_code": "920695825",
            "telephone_number": "760-743-3714",
            "fax_number": "760-736-4173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN SHADOWS SUPPORT GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-18",
        "last_updated": "2016-03-23",
        "status": "A",
        "authorized_official_last_name": "WILDE",
        "authorized_official_first_name": "WADE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "760-743-3714"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": "550003036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "550003036",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mtn. Shadows Community Homes- Fig House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Marcos, CA

Sources for this page

Verify at the official NPI Registry.