Mountain Shadows Support Group
NPI #1104280361 in Jurupa Valley, California
Provider Information
- NPI Number
- 1104280361
- Entity Type
- Organization
- Organization Name
- Mountain Shadows Support Group
- Primary Specialty
- Intermediate Care Facility, Intellectual Disabilities
- Enumeration Date
- Apr 13, 2016
- Last Updated
- Apr 19, 2016
Practice Location
- Address
- 4287 GARTH ST
- City
- Jurupa Valley
- State
- California
- ZIP Code
- 92509-3316
- Phone
- (760) 743-3714
Authorized Official
- Name
- LUPE BRYSON
- Title
- BUSINESS OFFICE MANAGER
- Phone
- (760) 743-3714
Specialties & Taxonomy Codes
| Specialty |
|---|
| Intermediate Care Facility, Intellectual Disabilities |
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