MEDICARE: MONARCH PROVIDER GROUP

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1881329654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONARCH PROVIDER GROUP

Provider Business Mailing Address
First Line	:	350 N GLENDALE AVE STE B220
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-3794
Country	:	US
Telephone Number	:	415-412-4790
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 N GLENDALE AVE STE B220
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-3794
Country	:	US
Telephone Number	:	415-412-4790
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE OWNER
Name	:	JULIE FITT
Credential	:
Telephone Number	:	415-412-4790

Provider Enumeration Date	:	07/17/2022
Last Update Date	:	07/17/2022

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