Organization
MONTE NIDO LAKE VISTA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE BAGLEY (CHIEF FINANCIAL OFFICER)
(305) 663-1876
Entity
Organization
Contact information
Practice address
28855 LAKE VISTA DR, AGOURA HILLS, CA 91301-2801
(818) 338-7890
(818) 338-7897
Mailing address
6100 SW 76TH ST, SOUTH MIAMI, FL 33143-5002
(305) 663-1876
(786) 359-4485
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
550000662
CA
Other
Enumeration date
02/11/2008
Last updated
05/27/2020
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