Organization
MONTE NIDO GEORGIA LLC
Active
Other names
Clementine Atlanta
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MIKE BAGLEY (CHIEF FINANCIAL OFFICER)
(305) 663-1876
Entity
Organization
Contact information
Practice address
124 JOHNSON FERRY RD NE, SANDY SPRINGS, GA 30328-3004
(305) 663-1876
(786) 359-4485
Mailing address
6100 SW 76TH ST, SOUTH MIAMI, FL 33143-5002
(305) 663-1876
(786) 359-4485
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Enumeration date
03/27/2020
Last updated
02/22/2023
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