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Mountain Shadows Support Group
Intellectual Disabilities Intermediate Care Facility in San Marcos, California
NPI 1992107221

Mountain Shadows Support Group is a Intellectual Disabilities Intermediate Care Facility based in San Marcos, CA. Mountain Shadows Support Group practices in San Marcos, CA. The NPI Number for Mountain Shadows Support Group is 1992107221 and holds a License No. 550003036 (California).

The current practice location address for Mountain Shadows Support Group is 689 Dane Dr, San Marcos, CA and can be reached out via phone at 760-743-3714 and via fax at 760-736-4173.

Location: 689 Dane Dr, San Marcos, CA, 92069-1475
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1992107221
Provider Name
Mountain Shadows Support Group
Credential
Provider Entity Type
Organization
Address
689 Dane Dr, San Marcos, CA, 92069-1475
Phone Number
760-743-3714
Fax Number
760-736-4173
Provider Enumeration Date
09/18/2014
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
550003036 05 CA
institution
Provider Business Practice Location Address Details
Address
689 Dane Dr
City
San Marcos
State
California
Zip
92069-5825
Phone Number
760-743-3714
Fax Number
760-736-4173
person
Provider Business Mailing Address Details
Address
689 Dane Dr
City
San Marcos
State
California
Zip
92069-5825
Phone Number
760-743-3714
Fax Number
760-736-4173
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Intermediate Care Facility, Mentally Retarded
Speciality
-
Taxonomy
315P00000X
License No.
550003036 (California)
Definition
(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.
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