Provider Demographics
NPI:1689395519
Name:MOMENTUM AGENCIES
Entity Type:Organization
Organization Name:MOMENTUM AGENCIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAROTTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-782-2211
Mailing Address - Street 1:6430 INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-2607
Mailing Address - Country:US
Mailing Address - Phone:818-782-2211
Mailing Address - Fax:
Practice Address - Street 1:19745 REDWING ST
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2616
Practice Address - Country:US
Practice Address - Phone:818-782-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOMENTUM AGENCIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities