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General NPI Number Information
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NPI Number | 1477846400
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Entity Type | Organization
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Legal Business Name | AURORA BEHAVIORAL HEALTHCARE - MONTE VISTA, LLC
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Dates
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Enumeration Date | 05/24/2011
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Last Update Date | 05/25/2011
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Provider Practice Location Address
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Address Line | 5900 W ROCHELLE AVE
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City | LAS VEGAS
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State | NV
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Zip | 89103-3304
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Country | US
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Telephone | 248-905-5091
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Fax | 248-905-5096
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Provider Business Mailing Address
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Address Line | 29433 SOUTHFIELD RD SUITE 201
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2031
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Country | US
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Telephone | 248-905-5091
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Fax | 248-905-5096
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. SOON K KIM
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Credential | M.D.
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Telephone | 248-905-5091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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