Provider Demographics
NPI:1396592705
Name:MARAVILLA ESTATE LLC
Entity type:Organization
Organization Name:MARAVILLA ESTATE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-801-5208
Mailing Address - Street 1:1576 E SPRUCE ST APT A
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-9406
Mailing Address - Country:US
Mailing Address - Phone:714-801-5208
Mailing Address - Fax:
Practice Address - Street 1:1576 E SPRUCE ST APT A
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-9406
Practice Address - Country:US
Practice Address - Phone:714-801-5208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility