Provider Demographics
NPI:1356000640
Name:LAGO MENTAL HEALTH CORP
Entity Type:Organization
Organization Name:LAGO MENTAL HEALTH CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ADLAY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGO JR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-534-8408
Mailing Address - Street 1:11055 SW 186TH ST STE 2017
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6840
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11055 SW 186TH ST STE 2017
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6840
Practice Address - Country:US
Practice Address - Phone:786-483-5523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110058400Medicaid