Healthcare Provider Details

I. General information

NPI: 1194271270
Provider Name (Legal Business Name): MONTAGE RECOVERY SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15350 SUTTON STREET
SHERMAN OAKS CA
91402-3824
US

IV. Provider business mailing address

203 S ORANGE DR
LOS ANGELES CA
90036-3010
US

V. Phone/Fax

Practice location:
  • Phone: 818-299-3602
  • Fax:
Mailing address:
  • Phone: 805-616-0719
  • Fax: 805-830-1565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

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