Provider Demographics
NPI:1417367889
Name:MARAVA CORPORATION
Entity Type:Organization
Organization Name:MARAVA CORPORATION
Other - Org Name:ISABEL CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELSO
Authorized Official - Middle Name:
Authorized Official - Last Name:AVARICIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-554-3305
Mailing Address - Street 1:441 N CAMINO ALTO
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-3313
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:441 N CAMINO ALTO
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-3313
Practice Address - Country:US
Practice Address - Phone:707-554-3305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA486801778311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home