MEDICARE: FORTIFY WELLNESS

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1104782432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORTIFY WELLNESS

Provider Business Mailing Address
First Line	:	17045 CHATSWORTH ST
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-5845
Country	:	US
Telephone Number	:	714-624-7171
Fax Number	:

Provider Business Practice Location Address
First Line	:	17045 CHATSWORTH ST
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-5845
Country	:	US
Telephone Number	:	714-624-7171
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	HENRY HSU
Credential	:	CADC
Telephone Number	:	714-624-7171

Provider Enumeration Date	:	12/30/2025
Last Update Date	:	12/30/2025

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Directions to “FORTIFY WELLNESS ” Practice Location

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