Monte Nido Lake Vista, LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

550000662 Issued in CA

Legal business name

MONTE NIDO LAKE VISTA, LLC

Practice address

28855 Lake Vista Dr
Agoura Hills, CA 91301-2801

Phone

(818) 338-7890

Fax

(818) 338-7897

NPI assigned

Feb 11, 2008

Organization subpart

No

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

Authorized official

Name

Mike Bagley

Title

Chief Financial Officer

Phone

(305) 663-1876

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

Tax ID family

Monte Nido Lake Vista LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Monte Nido Lake Vista, LLC

  dba Monte Nido East Bay

  • Mental Illness Community Based Residential Treatment Facility
  • Lafayette, CA
  • NPI 1053934984
  NPD tax ID
• Monte Nido Lake Vista, LLC

  dba Clementine Orange County

  • Adolescent and Children Mental Health Clinic/Center
  • Yorba Linda, CA
  • NPI 1609501279
  NPD tax ID
• Monte Nido Lake Vista, LLC

  dba Clementine Malibu Lake

  • Adolescent and Children Mental Health Clinic/Center
  • Agoura Hills, CA
  • NPI 1780105551
  NPD tax ID

Locations

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

{
    "created_epoch": "1202688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590537600000",
    "number": "1730357930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6100 SW 76TH ST",
            "city": "SOUTH MIAMI",
            "state": "FL",
            "postal_code": "331435002",
            "telephone_number": "305-663-1876",
            "fax_number": "786-359-4485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28855 LAKE VISTA DR",
            "city": "AGOURA HILLS",
            "state": "CA",
            "postal_code": "913012801",
            "telephone_number": "818-338-7890",
            "fax_number": "818-338-7897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTE NIDO LAKE VISTA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-11",
        "last_updated": "2020-05-27",
        "certification_date": "2020-05-27",
        "status": "A",
        "authorized_official_last_name": "BAGLEY",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "305-663-1876"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "CA",
            "license": "550000662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mindbody Hospice Inc
• Hannah Mogul
• Akikur Reza Mohammad, M.D.
• Samantha Nicole Molinar, LMFT
• Janine Molnar
• Monte Nido Lake Vista, LLC (Clementine Malibu Lake)
• Fernanda Monteon Ibarra, AGACNP-BC
• Megan Moran
• Paloma Moran, PSYD, LP
• Johnnie C Morgan IV, DC

• Mental Illness Community Based Residential Treatment Facility in Agoura Hills, CA
• Providers in Agoura Hills, CA by specialty
• Mental Illness Community Based Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2020; 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.