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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1679418461
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	:

Provider Business Practice Location Address
First Line	:	43875 WASHINGTON ST
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-8249
Country	:	US
Telephone Number	:	818-371-4532
Fax Number	:	805-830-1565

Authorized Official
Title or Position	:	VP
Name	:	JOANN ZUNIGA
Credential	:
Telephone Number	:	805-437-6515

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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