Provider Demographics
NPI:1932448685
Name:MOMENTUM AGENCIES
Entity Type:Organization
Organization Name:MOMENTUM AGENCIES
Other - Org Name:UCP/SCF MISSION HOUSE
Other - Org Type:Other Name
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:818-704-3942
Practice Address - Street 1:18509 SAN FERNANDO MISSION BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91326-2434
Practice Address - Country:US
Practice Address - Phone:818-366-2483
Practice Address - Fax:818-363-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities