OrganizationActive
Mountain Shadows Support Group, Inc
NPI 1700901931 · Nursing Facility/Intermediate Care Facility · Moreno Valley, CA
Provider details
- NPI number
- 1700901931
- Entity type
- Organization
- Primary specialty
- Nursing Facility/Intermediate Care FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Lupe Bryson, Business Office Manager(760) 743-3714
- License
- 46989489 (CA)
Specialties & taxonomies
Nursing & Custodial Care Facilities
Profile Score
Detailed profile(89/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
11315 Lindley Ln
Moreno Valley, CA 92555-5285
Phone: (760) 743-3714
Fax: (760) 743-9937
Street-level locationGet directions
Mailing address
2067 W El Norte Pkwy
Escondido, CA 92026-1810
Other names (DBA / former)
- Doing business as
- Special Kids Homes-Lindley Lane
Registry dates
- Enumerated
- 2007-03-20
- Last updated
- 2007-12-26
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.