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General NPI Number Information
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NPI Number | 1902529076
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Entity Type | Organization
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Legal Business Name | MONTE NIDO NEW JERSEY LLC
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Dates
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Enumeration Date | 09/22/2022
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Last Update Date | 09/23/2022
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Provider Practice Location Address
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Address Line | 120 MUNN LN
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City | CHERRY HILL
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State | NJ
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Zip | 08034-3030
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Country | US
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Telephone | 856-626-5100
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Fax | 856-428-1629
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Provider Business Mailing Address
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Address Line | 6100 SW 76TH STREET MONTE NIDO AFFILIATES
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City | SOUTH MIAMI
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State | FL
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Zip | 33143
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Country | US
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Telephone | 305-663-1876
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. MIKE BAGLEY
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Credential |
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Telephone | 305-663-1876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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