Maple Moon Recovery

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

MAPLE MOON RECOVERY

Practice address

20400 Hemmingway St
Winnetka, CA 91306-2249

Phone

(213) 713-8027

NPI assigned

Dec 22, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ashley Ingram

Title

Owner

Phone

(213) 713-8027

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1640131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640131200000",
    "number": "1184384786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20400 HEMMINGWAY ST",
            "city": "WINNETKA",
            "state": "CA",
            "postal_code": "913062249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20400 HEMMINGWAY ST",
            "city": "WINNETKA",
            "state": "CA",
            "postal_code": "913062249",
            "telephone_number": "213-713-8027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE MOON RECOVERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-22",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A",
        "authorized_official_last_name": "INGRAM",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "213-713-8027"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric Christian Lyden, M.A.
• Kevin Lyons
• Eric Jason Maize
• Damir R Malikov, L.AC., M.S.O.M.
• Katherine Escarleth Manzano
• Najah Marino, BSN, RN
• Lester Antonio Marlin
• Jesse James Massarella
• Mastery Behavior Solutions LLC
• Maxi Care RX

• Substance Abuse Rehabilitation Facility in Winnetka, CA
• Providers in Winnetka, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.