Organization
MONTE NIDO LAKE VISTA, LLC
Active
Parent organization
MONTE NIDO LAKE VISTA, LLC
Other names
Monte Nido East Bay
Organization subpart
Yes
Provider details
NPI number
Legal business name
MONTE NIDO LAKE VISTA, LLC
Authorized official
MIKE BAGLEY (CHIEF FINANCIAL OFFICER)
(305) 663-1876
Entity
Organization
Contact information
Practice address
1776 IVANHOE AVE, LAFAYETTE, CA 94549-1954
(305) 663-1876
(786) 359-4485
Mailing address
6100 SW 76TH ST, SOUTH MIAMI, FL 33143-5002
(305) 663-1876
(305) 663-1876
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/27/2020
Last updated
05/27/2020
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