MONTAGE RECOVERY CA, LLC (NPI# 1710433891) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710433891 |
| Entity Type | Organization |
| Organization Name | MONTAGE RECOVERY CA, LLC |
| Other Organization Name | COSTA COLINA |
| Practice Address |
3341 Country Club Dr Los Angeles CA 90019-3535 |
| Practice Telephone | 8057024273 |
| Practice Fax Number | 8186986442 |
| Mailing Telephone | 8057024273 |
| Mailing Fax Number | 8186986442 |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2019-10-08 |
| Authorized Official Name | JOANN ZUNIGA (COO) |
| Authorized Official Telephone | 8056160719 |
| Is Organization Subpart | Y |
| Parent Organization Name | MONTAGE RECOVERY SOLUTIONS |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 324500000X | Substance Abuse Rehabilitation Facility | CA | Residential Treatment Facilities | |
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | CA | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Costa Colina | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 5 Vista Ct, Laguna Niguel, CA 926777973 | 8888460621 | 8888460621 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902438393 | Montage Recovery Ca, LLC | Clinic/Center | 2890 Kanan Dume Road, Malibu, CA 90265 | 2020-02-04 |
| Street Address |
3341 COUNTRY CLUB DR |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90019-3535 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629604764 | Christina Lucey-ventura | Counselor | 3341 Country Club Dr, Los Angeles, CA 90019-3535 | 2020-03-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386299139 | Garfield Beach Cvs LLC | Durable Medical Equipment & Medical Supplies | 1302 South La Brea, Los Angeles, CA 90019 | 2019-08-08 |
| 1104383694 | 310 Recovery Inc. | Clinic/Center | 1723 1/2 Hauser Blvd, Los Angeles, CA 90019 | 2019-02-21 |
| 1184131328 | Sehyeong Son | Acupuncturist | 1722 Crenshaw Blvd, Los Angeles, CA 90019 | 2018-01-09 |
| 1285158154 | Vanessa A. Myrie | Social Worker | 5562 Packard St., Los Angeles, CA 90019 | 2017-08-01 |
| 1093241309 | Hamburger Home | Community/Behavioral Health | 4066 W. 17th Street, Los Angeles, CA 90019 | 2017-05-05 |
| 1639614779 | Jung Ho Kang | Acupuncturist | 903 S. Crenshaw Blvd #304a, Los Angeles, CA 90019 | 2016-12-28 |
| 1912353491 | Sung Won Lee | Acupuncturist | 4027 W. Pico Bl., Los Angeles, CA 90019 | 2016-05-13 |
| 1497188528 | Sfvcmhc | Community/Behavioral Health | 5754 San Vicente Blvd, 401, Los Angeles, CALIFORNIA 90019 | 2013-08-13 |
| 1467890160 | Denise Breheny | Lactation Consultant, Non-RN | 1053 Carmona Ave., Los Angeles, CA 90019 | 2013-06-05 |
| 1336483122 | Nancy Denise - Latten Davidson | Student in an Organized Health Care Education/Training Program | 4073-75 West Pico Blvd, Los Angeles, CA 90019 | 2012-11-16 |
| Find all providers in zip 90019 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386283984 | Aptus Pacem, LLC | Community Based Residential Treatment Facility, Mental Illness | 5035 E Echo St, Los Angeles, CA 90042-3915 | 2019-12-30 |
| 1023578705 | Mindful Growth Foundation | Community Based Residential Treatment Facility, Mental Illness | 1208 W 38th St, Los Angeles, CA 90037-1106 | 2019-03-20 |
| 1114491636 | Mindful Growth Foundation | Community Based Residential Treatment Facility, Mental Illness | 3924 W Adams Blvd, Los Angeles, CA 90018-1755 | 2019-01-17 |
| 1467963256 | Special Service for Groups, Inc. | Community Based Residential Treatment Facility, Mental Illness | 2178 Firestone Blvd, Los Angeles, CA 90002 | 2017-10-19 |
| 1184169815 | Exodus Recovery, Inc. | Community Based Residential Treatment Facility, Mental Illness | 3754-56 Overland Ave, Los Angeles, CA 90034-6312 | 2017-01-04 |
| 1205262748 | Reese's Board and Care Home | Community Based Residential Treatment Facility, Mental Illness | 11205 Monitor Ave, Los Angeles, CA 90059-1935 | 2013-09-16 |
| 1093152076 | Bridges To Recovery IIii | Community Based Residential Treatment Facility, Mental Illness | 10201 Charing Cross Rd, Los Angeles, CA 90024-1814 | 2013-05-30 |
| 1104199033 | Adrienne James | Community Based Residential Treatment Facility, Mental Illness | 3776 S Gramercy Pl, One Half, Los Angeles, CA 90018-4377 | 2012-02-23 |
| 1144593518 | Dmhlac Eob Pmrt Sa5 | Community Based Residential Treatment Facility, Mental Illness | 11303 W, Olympic Boulevard, Los Angeles, CA 90066 | 2012-02-16 |
| 1396014544 | Bridges To Recovery IIi | Community Based Residential Treatment Facility, Mental Illness | 777 Sarbonne Rd, Los Angeles, CA 90077-3320 | 2011-12-16 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90019 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.