MONTE NIDO LAKE VISTA LLC NPI 1730357930

NPI Information

  • NPI: 1730357930
  • Provider Name: MONTE NIDO LAKE VISTA, LLC
  • Classification: Community Based Residential Treatment Facility, Mental Illness - 320800000X
  • Entity Type: Organization
  • CLIA Number: 05D2092574
  • Address: 28855 LAKE VISTA DR
    AGOURA HILLS, CA
    ZIP 91301
  • Phone: (818) 338-7890

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NPI Details

MONTE NIDO LAKE VISTA, LLC is a community based residential treatment facility mental illness in Agoura Hills, CA. The provider is a home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. MONTE NIDO LAKE VISTA, LLC NPI is 1730357930. The provider is registered as an organization entity type.

The provider's business location address is:

28855 LAKE VISTA DR
AGOURA HILLS, CA
ZIP 91301-801
Phone: (818) 338-7890
Fax: (818) 338-7897

The provider's authorized official is Mike Bagley .
The authorized official title is Chief Financial Officer and has the following contact phone number (305) 663-1876.

The CLIA number assigned to this NPI record is 05D2092574 - other - resi mental hlth facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/11/2008 and was last updated on 5/27/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1320800000XCommunity Based Residential Treatment Facility, Mental Illness550000662CALIFORNIAYes

What is NPI?

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This page was last updated on: 11/21/2025

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