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General NPI Number Information
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NPI Number | 1962272666
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Entity Type | Organization
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Legal Business Name | MONTE NIDO ILLINOIS, LLC
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Dates
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Enumeration Date | 01/03/2024
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Last Update Date | 06/26/2024
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Provider Practice Location Address
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Address Line | 701 E 22ND ST STE 250
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City | LOMBARD
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State | IL
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Zip | 60148-2400
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Country | US
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Telephone | 305-663-1876
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Fax |
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Provider Business Mailing Address
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Address Line | 6100 SW 76TH ST
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5002
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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 | EDWARD MOODY
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Credential |
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Telephone | 571-334-3144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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