Healthcare Provider Details

I. General information

NPI: 1801585112
Provider Name (Legal Business Name): MOMENTOUS RECOVERY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19642 BALLINGER ST
NORTHRIDGE CA
91324-2103
US

IV. Provider business mailing address

19642 BALLINGER ST
NORTHRIDGE CA
91324-2103
US

V. Phone/Fax

Practice location:
  • Phone: 818-626-9790
  • Fax:
Mailing address:
  • Phone: 818-617-5090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: VANESSA FENWICK
Title or Position: CEO
Credential:
Phone: 818-617-5090