Provider Demographics
NPI:1710433891
Name:MONTAGE RECOVERY CA, LLC
Entity Type:Organization
Organization Name:MONTAGE RECOVERY CA, LLC
Other - Org Name:COSTA COLINA
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 1:14339 VALLEY VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-4027
Mailing Address - Country:US
Mailing Address - Phone:805-616-0719
Mailing Address - Fax:805-830-1565
Practice Address - Street 1:14339 VALLEY VISTA BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-4027
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:2016-08-29
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
320800000X, 323P00000X
CA324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility