NPI 1992107221

Mountain Shadows Support Group

Organisation Intellectual Disabilities Intermediate Care Facility San Marcos, CA

Practice location

Address: 689 Dane Dr, San Marcos, CA 92069-5825
Phone: (760) 743-3714
Fax: (760) 736-4173
Mailing address: 970 Los Vallecitos Blvd STE 240, San Marcos, CA 92069-1475

Authorised official

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

Registered specialties

Intellectual Disabilities Intermediate Care Facility Primary

Nursing & Custodial Care Facilities Taxonomy 315P00000X Licence 550003036 (CA)

Other Intermediate Care Facility, Intellectual Disabilities providers in California →

Registry record

NPI: 1992107221
Entity type: Organization
NPI issued: 18 Sep 2014
Record last updated: 23 Mar 2016

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.