Monte Nido Lake Vista, LLC
NPI #1053934984 in Lafayette, California
Provider Information
- NPI Number
- 1053934984
- Entity Type
- Organization
- Organization Name
- Monte Nido Lake Vista, LLC
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- MONTE NIDO LAKE VISTA, LLC
- Primary Specialty
- Community Based Residential Treatment Facility, Mental Illness
- Enumeration Date
- May 27, 2020
- Last Updated
- May 27, 2020
Practice Location
- Address
- 1776 IVANHOE AVE
- City
- Lafayette
- State
- California
- ZIP Code
- 94549-1954
- Phone
- (305) 663-1876
Authorized Official
- Name
- MIKE BAGLEY
- Title
- CHIEF FINANCIAL OFFICER
- Phone
- (305) 663-1876
Specialties & Taxonomy Codes
| Specialty |
|---|
| Community Based Residential Treatment Facility, Mental Illness |
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