SHADOW MOUNTAIN RECOVERY, TAOS – NPI #1295154888
Substance Abuse Rehabilitation Facility

A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

Health Care Provider Taxonomy Code for Substance Abuse Rehabilitation Facility

SHADOW MOUNTAIN RECOVERY, TAOS is a substance abuse rehabilitation facility located in TAOS, NM. NPPES has assigned the NPI number 1295154888 to SHADOW MOUNTAIN RECOVERY, TAOS on April 10, 2014. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “SHADOW MOUNTAIN RECOVERY, TAOS” is a dba name, the actual legal business name for this organization is SHADOW MOUNTAIN LLC.. The primary taxonomy selected by this provider is 324500000X from the Health Care Provider Taxonomy code set, which is classified as Substance Abuse Rehabilitation Facility.

The NPI profile was previously updated about 9 years ago on May 10, 2017. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for SHADOW MOUNTAIN RECOVERY, TAOS below.

NPI Profile for
SHADOW MOUNTAIN LLC.

NPI Number
1295154888
Enumeration Date

(more than 12 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
SHADOW MOUNTAIN LLC.
Doing Business As (dba): SHADOW MOUNTAIN RECOVERY, TAOS
Primary location
250 SHADOW MOUNTAIN RD.
TAOS, NM 87571
Phone: (575) 751-4851 Fax:
Mailing address
PO BOX 830525
DEPARTMENT # SF 57
BIRMINGHAM, AL 35283-0525
Phone: (931) 451-7757 Fax: (931) 933-7762
Organization Subpart
No
Authorized Official
JACKIE HOLUB
VICE PRESIDENT
Phone: (925) 389-8591
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
324500000X
- Substance Abuse Rehabilitation Facility (Primary)		 NM STATE WAIVER

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.