MEDICARE: MONTAGE RECOVERY SOLUTIONS

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	:	1720762339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTAGE RECOVERY SOLUTIONS

Provider Business Mailing Address
First Line	:	203 S ORANGE DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-3010
Country	:	US
Telephone Number	:	818-299-3602
Fax Number	:

Provider Business Practice Location Address
First Line	:	17167 VENTURA BLVD STE 300
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-4004
Country	:	US
Telephone Number	:	818-299-2602
Fax Number	:	805-830-1565

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

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	06/14/2023

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