Provider Demographics
NPI:1902438393
Name:MONTAGE RECOVERY CA, LLC
Entity Type:Organization
Organization Name:MONTAGE RECOVERY CA, LLC
Other - Org Name:RENEWAL BEHAVIORAL HEALTH OUTPATIENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUNIGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-616-0719
Mailing Address - Street 1:203 S ORANGE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3010
Mailing Address - Country:US
Mailing Address - Phone:805-702-4273
Mailing Address - Fax:818-830-1565
Practice Address - Street 1:2890 KANAN DUME ROAD
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265
Practice Address - Country:US
Practice Address - Phone:818-299-3602
Practice Address - Fax:805-830-1565
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTAGE RECOVERY CA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-04
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health