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NPI Code Detail

MEDICARE: THE MEADOWGLADE, LLC

MEDICARE: THE MEADOWGLADE, 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
1261QM0850XAdult Mental Health Clinic/Center
2323P00000XPsychiatric Residential Treatment Facility

General Provider Information

NPI Number : 1548823032
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE MEADOWGLADE, LLC
Provider Business Mailing Address
First Line : 6053 BRISTOL PKWY
Second Line :
City : CULVER CITY
State : CA
Zip : 90230-6601
Country : US
Telephone Number : 323-364-6489
Fax Number :
Provider Business Practice Location Address
First Line : 5231 MAUREEN LN # A
Second Line :
City : MOORPARK
State : CA
Zip : 93021-7125
Country : US
Telephone Number : 323-880-2110
Fax Number :
Authorized Official
Title or Position : REVENUE CYCLE MANAGER
Name : TERRY SCHOSER
Credential :
Telephone Number : 323-364-6489
Provider Enumeration Date : 04/19/2019
Last Update Date : 10/16/2025

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