05D2092574 CLIA NUMBER - MONTE NIDO VISTA

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Laboratory Demographics

CLIA Number: 05D2092574

Facility Name: MONTE NIDO VISTA

Facility Address:
28855 LAKE VISTA DRIVE
AGOURA HILLS, CA
ZIP 91301
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Facility Phone Number: 818 338-7890

Facility Type: Other - RESI MENTAL HLTH FACILITY

Certificate Type: Waiver

NPI Number: 1730357930

Taxonomy: 320800000X - Community Based Residential Treatment Facility, Mental Illness
A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.

CLIA Record

Field Name	Field Value
CLIA Number	05D2092574
LAB Type	Other - RESI MENTAL HLTH FACILITY
Facility Name	MONTE NIDO VISTA
Street	28855 LAKE VISTA DRIVE
City	AGOURA HILLS
State	CA
ZIP	91301
Phone	818 338-7890
CertificateType	4
CertificateEffectiveDate	3/9/2023
CertificateExpirationDate	3/8/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024