Organization
CLOVERLEAF ENTERPRISE INC
Active
Other names
Cherry Valley Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTHONY ALBERT LOPEZ NHA (ADMINISTRATOR)
(951) 845-1606
Entity
Organization
Contact information
Practice address
5800 W WILSON ST, BANNING, CA 92220-3042
(951) 845-1606
(951) 845-4152
Mailing address
5800 W WILSON ST, BANNING, CA 92220-3042
(951) 845-1606
(951) 845-4152
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
250000298
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC55309G
—
CA
Enumeration date
11/09/2005
Last updated
03/30/2022
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