Provider Demographics
NPI:1699308155
Name:MILES PLACE, INC.
Entity type:Organization
Organization Name:MILES PLACE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REINER
Authorized Official - Middle Name:
Authorized Official - Last Name:AVENDANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-273-9951
Mailing Address - Street 1:25751 CHRISANTA DR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5607
Mailing Address - Country:US
Mailing Address - Phone:949-273-9951
Mailing Address - Fax:844-308-6564
Practice Address - Street 1:25451 ADRIANA ST
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-3817
Practice Address - Country:US
Practice Address - Phone:949-458-7869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA306005754OtherCCLD
CA306005765OtherCCLD
CA306005766OtherCCLD