Healthcare Provider Details

I. General information

NPI: 1215892849
Provider Name (Legal Business Name): MONTAGE RECOVERY CA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17167 VENTURA BLVD STE 100
ENCINO CA
91316-4004
US

IV. Provider business mailing address

17167 VENTURA BLVD STE 100
ENCINO CA
91316-4004
US

V. Phone/Fax

Practice location:
  • Phone: 805-437-6515
  • Fax: 805-830-1565
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOANN ZUNIGA
Title or Position: VP
Credential:
Phone: 805-616-0719