MEDICARE: MONTAGE RECOVERY CA, LLC

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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1235997289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTAGE RECOVERY CA, LLC

Provider Business Mailing Address
First Line	:	203 S ORANGE DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-3010
Country	:	US
Telephone Number	:
Fax Number	:	805-830-1565

Provider Business Practice Location Address
First Line	:	5316 LUBAO AVE
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-3623
Country	:	US
Telephone Number	:	818-299-3602
Fax Number	:	805-830-1565

Authorized Official
Title or Position	:	VP
Name	:	JOANN ZUNIGA
Credential	:
Telephone Number	:	805-616-0719

Provider Enumeration Date	:	03/13/2024
Last Update Date	:	03/13/2024

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