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 |