Provider Demographics
NPI:1548823032
Name:THE MEADOWGLADE, LLC
Entity type:Organization
Organization Name:THE MEADOWGLADE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-364-6489
Mailing Address - Street 1:6053 BRISTOL PKWY
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6601
Mailing Address - Country:US
Mailing Address - Phone:323-364-6489
Mailing Address - Fax:
Practice Address - Street 1:301 SCIENCE DR STE 210
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-0801
Practice Address - Country:US
Practice Address - Phone:323-880-2110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-19
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty