Healthcare Provider Details

I. General information

NPI: 1548823032
Provider Name (Legal Business Name): THE MEADOWGLADE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2019
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5231 MAUREEN LN # A
MOORPARK CA
93021-7125
US

IV. Provider business mailing address

6053 BRISTOL PKWY
CULVER CITY CA
90230-6601
US

V. Phone/Fax

Practice location:
  • Phone: 323-880-2110
  • Fax:
Mailing address:
  • Phone: 323-364-6489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: TERRY SCHOSER
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 323-364-6489