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NPI Code Detail

MEDICARE: AURORA BEHAVIORAL HEALTHCARE - MONTE VISTA, LLC

MEDICARE: AURORA BEHAVIORAL HEALTHCARE - MONTE VISTA, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1302R00000XHealth Maintenance Organization

General Provider Information

NPI Number : 1477846400
Entity Type Code : Organization
Provider Name (Legal Business Name) : AURORA BEHAVIORAL HEALTHCARE - MONTE VISTA, LLC
Provider Business Mailing Address
First Line : 29433 SOUTHFIELD RD
Second Line : SUITE 201
City : SOUTHFIELD
State : MI
Zip : 48076-2031
Country : US
Telephone Number : 248-905-5091
Fax Number : 248-905-5096
Provider Business Practice Location Address
First Line : 5900 W ROCHELLE AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-3304
Country : US
Telephone Number : 248-905-5091
Fax Number : 248-905-5096
Authorized Official
Title or Position : SOLE MEMBER
Name : DR. SOON K KIM
Credential : M.D.
Telephone Number : 248-905-5091
Provider Enumeration Date : 05/24/2011
Last Update Date : 05/25/2011

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