Provider Demographics
NPI:1477846400
Name:AURORA BEHAVIORAL HEALTHCARE - MONTE VISTA, LLC
Entity Type:Organization
Organization Name:AURORA BEHAVIORAL HEALTHCARE - MONTE VISTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOON
Authorized Official - Middle Name:K
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-905-5091
Mailing Address - Street 1:29433 SOUTHFIELD RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2031
Mailing Address - Country:US
Mailing Address - Phone:248-905-5091
Mailing Address - Fax:248-905-5096
Practice Address - Street 1:5900 W ROCHELLE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3304
Practice Address - Country:US
Practice Address - Phone:248-905-5091
Practice Address - Fax:248-905-5096
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIGNATURE HEALTHCARE SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-24
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization