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NPI Code Detail

MEDICARE: MOMENTUM BEHAVIOR SERVICES, LLC

MEDICARE: MOMENTUM BEHAVIOR SERVICES, 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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1356825541
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOMENTUM BEHAVIOR SERVICES, LLC
Provider Business Mailing Address
First Line : 818 NORTH BLVD
Second Line :
City : OAK PARK
State : IL
Zip : 60301-1302
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1301 REDWOOD WAY STE 210
Second Line :
City : PETALUMA
State : CA
Zip : 94954-1134
Country : US
Telephone Number : 707-806-9921
Fax Number :
Authorized Official
Title or Position : CHIEF DEVELOPMENT OFFICER
Name : HANNAH FRANZ-MESICK
Credential :
Telephone Number : 707-806-9921
Provider Enumeration Date : 09/24/2018
Last Update Date : 06/05/2026

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Directions to “MOMENTUM BEHAVIOR SERVICES, LLC ” Practice Location

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