MEDICARE: MOMENTUM AGENCIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1013169259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOMENTUM AGENCIES

Provider Business Mailing Address
First Line	:	6430 INDEPENDENCE AVE
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-2607
Country	:	US
Telephone Number	:	818-782-2211
Fax Number	:	818-909-9106

Provider Business Practice Location Address
First Line	:	9205 WHITE OAK AVE
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91325-2335
Country	:	US
Telephone Number	:	818-727-1067
Fax Number	:	818-701-2946

Authorized Official
Title or Position	:	ACCOUNTS RECEIVABLE MANAGER
Name	:	KIMBERLY MAROTTA
Credential	:
Telephone Number	:	818-782-2211

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	07/29/2022

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