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General NPI Number Information
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NPI Number | 1407527161
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Entity Type | Organization
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Legal Business Name | MONTAGE RECOVERY CA, LLC
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Dates
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Enumeration Date | 09/22/2021
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Last Update Date | 04/01/2022
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Provider Practice Location Address
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Address Line | 4156 SUNSWEPT DR
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City | STUDIO CITY
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State | CA
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Zip | 91604-2334
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Country | US
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Telephone | 805-437-6515
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Fax |
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Provider Business Mailing Address
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Address Line | 203 S ORANGE DR
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City | LOS ANGELES
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State | CA
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Zip | 90036-3010
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JOANN ZUNIGA
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Credential |
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Telephone | 805-616-0719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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