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MOUNTAIN SHADOWS SUPPORT GROUP, INC
NPI 1053436287
Nursing Facility/Intermediate Care Facility in Riverside, CA

Active since March 20, 2007
8163 LAUREL PARK CIR, RIVERSIDE, CA 92509(760) 743-3714(760) 736-4173 Get Directions Write a Review

NPPES record last updated: September 9, 2010. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mountain Shadows Support Group, Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MOUNTAIN SHADOWS SUPPORT GROUP, INC (NPI 1053436287), doing business as Special Kids Homes-maverick House, is a healthcare organization registered as a nursing facility/intermediate care facility in Riverside, California and active in the NPI registry since March 2007. The organization lists Lupe Bryson, Bussiness Office Manager, as its authorized official.

NPPES Registry Identity

NPI1053436287
Entity TypeOrganization
Primary Taxonomy313M00000X
Legal Business NameMOUNTAIN SHADOWS SUPPORT GROUP, INC
Location Address8163 LAUREL PARK CIRRiverside, CA 92509-4075
Mailing Address2067 W El Norte PkwyEscondido, CA 92026-1810 · (760) 743-3714 · Fax (760) 743-9937
Phone(760) 743-3714
Fax(760) 736-4173
Organization SubpartNo
Authorized OfficialLupe BrysonBussiness Office Manager · (760) 743-3714
Enumeration DateMarch 20, 2007
Last NPPES UpdateSeptember 9, 2010
✔ NPI 1053436287 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNursing Facility/Intermediate Care FacilityNursing & Custodial Care Facilities
Taxonomy Code313M00000X
License✔ Licensed in CA · 46989489
Definition
An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.
8163 LAUREL PARK CIR, Riverside, CA 92509
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Other Names 1

Former Legal Business NameSpecial Kids Homes-maverick House

Other Identifiers 2

MedicaidLTC80083GCA
MedicaidLTC80083FCA

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mountain Shadows Support Group, Inc's NPI number?

The NPI number for Mountain Shadows Support Group, Inc is 1053436287. It was assigned to this organization in the NPPES registry on March 20, 2007. The provider was formerly known as Special Kids Homes-Maverick House.

Where is Mountain Shadows Support Group, Inc located?

Mountain Shadows Support Group, Inc is located at 8163 Laurel Park Cir, Riverside, CA 92509. The listed phone number is (760) 743-3714.

What is Mountain Shadows Support Group, Inc's specialty?

The primary specialty registered for this NPI is Nursing Facility/Intermediate Care Facility with taxonomy code 313M00000X.

When was this NPI record last updated?

The NPPES record for Mountain Shadows Support Group, Inc was last updated on September 9, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.