Organization
CLOVERLEAF ENTERPRISES, INC.
Active
Other names
Banning Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARIO I BERTUMEN SR. NHA (ADMINISTRATOR)
(951) 849-4723
Entity
Organization
Contact information
Practice address
3476 W WILSON ST, BANNING, CA 92220-3420
(951) 849-4723
(951) 849-0972
Mailing address
3476 W WILSON ST, BANNING, CA 92220-3420
(951) 849-4723
(951) 849-0972
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC55319G
—
CA
Enumeration date
11/09/2005
Last updated
08/22/2020
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