| NPI | 1295154888 |
|---|---|
| Doing Business As | SHADOW MOUNTAIN RECOVERY, TAOS |
| Entity Type | Organization |
| Authorized Contact | JACKIE HOLUB Vice President 925-389-8591 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: NM State Waiver) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2017-05-10 |