NPI 1295154888

Shadow Mountain LLC.

Organisation Substance Abuse Rehabilitation Facility Taos, NM

Practice location

Address: 250 Shadow Mountain Rd., Taos, NM 87571
Phone: (575) 751-4851
Mailing address: PO Box 830525 Department # Sf 57, Birmingham, AL 35283-0525

Authorised official

Name: Jackie Holub
Title: Vice President
Phone: (925) 389-8591

Registered specialties

Substance Abuse Rehabilitation Facility Primary

Residential Treatment Facilities Taxonomy 324500000X Licence STATE WAIVER (NM)

Other Substance Abuse Rehabilitation Facility providers in New Mexico →

Registry record

NPI: 1295154888
Entity type: Organization
NPI issued: 10 Apr 2014
Record last updated: 10 May 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.