Provider Demographics
NPI:1417567884
Name:MOMENTUM IOP, LLC
Entity Type:Organization
Organization Name:MOMENTUM IOP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SVENSSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-741-7199
Mailing Address - Street 1:3101 WASHINGTON BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5577
Mailing Address - Country:US
Mailing Address - Phone:310-741-7199
Mailing Address - Fax:
Practice Address - Street 1:3101 WASHINGTON BLVD STE B
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5577
Practice Address - Country:US
Practice Address - Phone:310-741-7199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health