Healthcare Provider Details

I. General information

NPI: 1093604266
Provider Name (Legal Business Name): MARIPOSA MANOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 E MARIPOSA DR
REDLANDS CA
92373-7354
US

IV. Provider business mailing address

644 E MARIPOSA DR
REDLANDS CA
92373-7354
US

V. Phone/Fax

Practice location:
  • Phone: 909-557-4422
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: BRIAN HENLEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 909-557-4422