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General NPI Number Information
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NPI Number | 1598487027
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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 | 09/12/2022
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Last Update Date | 07/28/2023
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Provider Practice Location Address
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Address Line | 3341 COUNTRY CLUB DR
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City | LOS ANGELES
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State | CA
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Zip | 90019-3535
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Country | US
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Telephone | 818-299-3602
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Fax | 805-830-1565
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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 | 818-299-3602
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Fax | 805-830-1565
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Authorized Official
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Title or Position | DIRECTOR
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Name | JOANN ZUNIGA
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Credential |
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Telephone | 805-437-6515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 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 #3
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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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