Shadow Mountain Llc.
NPI #1295154888 in Taos, New Mexico
Provider Information
- NPI Number
- 1295154888
- Entity Type
- Organization
- Organization Name
- Shadow Mountain Llc.
- Primary Specialty
- Substance Abuse Rehabilitation Facility
- Enumeration Date
- Apr 10, 2014
- Last Updated
- May 10, 2017
Practice Location
- Address
- 250 SHADOW MOUNTAIN RD.
- City
- Taos
- State
- New Mexico
- ZIP Code
- 87571
- Phone
- (575) 751-4851
Authorized Official
- Name
- JACKIE HOLUB
- Title
- VICE PRESIDENT
- Phone
- (925) 389-8591
Specialties & Taxonomy Codes
| Specialty |
|---|
| Substance Abuse Rehabilitation Facility |
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