Organization
DAVID KLEIS III, LLC
Active
Other names
Miravilla Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MISS MAE T KNIGHT (ADMINISTRATOR)
(951) 845-3184
Entity
Organization
Contact information
Practice address
9246 AVENIDA MIRAVILLA, CHERRY VALLEY, CA 92223-3835
(951) 845-3194
(951) 845-2064
Mailing address
9246 AVENIDA MIRAVILLA, CHERRY VALLEY, CA 92223-3835
(951) 845-3194
(951) 845-2064
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZT05754G
—
CA
Enumeration date
11/15/2005
Last updated
08/22/2020
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