Healthcare Provider Details

I. General information

NPI: 1568322014
Provider Name (Legal Business Name): THE MEADOWGLADE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6446 MEADOWGLADE DR
MOORPARK CA
93021-9705
US

IV. Provider business mailing address

6446 MEADOWGLADE DR
MOORPARK CA
93021-9705
US

V. Phone/Fax

Practice location:
  • Phone: 888-272-2062
  • Fax: 310-919-0372
Mailing address:
  • Phone: 888-272-2062
  • Fax: 310-919-0372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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