# DAVID KLEIS III, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Miravilla Care Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063494276
- **Authorized official:** MISS MAE T KNIGHT (ADMINISTRATOR)
- **Authorized official phone:** (951) 845-3184

## Contact information

- **Practice address:** 9246 AVENIDA MIRAVILLA, CHERRY VALLEY, CA 92223-3835
- **Practice address phone:** (951) 845-3194
- **Practice address fax:** (951) 845-2064
- **Mailing address:** 9246 AVENIDA MIRAVILLA, CHERRY VALLEY, CA 92223-3835
- **Mailing address phone:** (951) 845-3194
- **Mailing address fax:** (951) 845-2064

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | CA | Yes |

## Other

- **Enumeration date:** 11/15/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZT05754G | — | CA |