David Kleis II, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

DAVID KLEIS II, LLC

Doing business as

Palm Grove Healthcare

Practice address

1665 E 8TH St
Beaumont, CA 92223-2512

Phone

(951) 845-3125

Fax

(951) 769-1582

NPI assigned

Nov 9, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miss Mae T Knight

Title

Administrator

Phone

(951) 845-3125

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Palm Grove Healthcare Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1598746182. Details of each certification follow.

• CCN 555740 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 555740

Legal name

DAVID KLEIS II, LLC

Doing business as

PALM GROVE HEALTHCARE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jul 26, 1999

Last certification

Jul 11, 2024

Beds

57

Ownership / control type

Limited Liability Corporation

Multi-facility organization

PACS

Organization structure

LLCProprietary

Incorporated

Jun 11, 1999 in CA

Enrollment address

1665 E 8TH St
Beaumont, CA 92223-2512

Nursing home name

VISTA REAL POST ACUTE

Affiliated entity

CHARIS TRUST DTD 12/22/16

Listed as

Vista Real Post AcuteCCN 555740 · All quality measures

Overall star rating

4 of 5

Health inspections

3 of 5

Staffing

4 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Jul 26, 1999

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

5754.6 residents per day on average

Chain

Charis Trust DTD 12/22/166 facilities in the chain

Penalties (3 years)

1Fines totaling $0

Processed by Care Compare on Aug 1, 2026.

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• Canyon Properties III, LLC

  dba Country Manor Healthcare

  • Skilled Nursing Facility
  • Lake View Terrace, CA
  • NPI 1790766376

  Charis TR DTD 12/22/2016

  CMS ownership
• Geri-Care Inc.

  dba Harbor Post-Acute Care Center

  • Skilled Nursing Facility
  • Torrance, CA
  • NPI 1053392639

  Charis TR DTD 12/22/2016

  CMS ownership
• Heritage Care, LLC

  dba Heritage Rehabilitation Center

  • Skilled Nursing Facility
  • Torrance, CA
  • NPI 1164410783

  Charis TR DTD 12/22/2016

  CMS ownership
• Washington Enterprises III, LLC

  dba St. Andrews Healthcare

  • Skilled Nursing Facility
  • Los Angeles, CA
  • NPI 1346221819

  Charis TR DTD 12/22/2016

  CMS ownership

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Andres Gonzalez, M.D.

  • Family Medicine Physician
  • Montclair, CA
  • NPI 1669892147

  Nursing home

  Care Compare affiliation
• Nawazish Shahdin Qazi, M.D.

  • Internal Medicine Physician
  • Banning, CA
  • NPI 1598881229

  Nursing home

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1598746182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1665 E 8TH ST",
            "city": "BEAUMONT",
            "state": "CA",
            "postal_code": "922232512",
            "telephone_number": "951-845-3125",
            "fax_number": "951-769-1582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1665 E 8TH ST",
            "city": "BEAUMONT",
            "state": "CA",
            "postal_code": "922232512",
            "telephone_number": "951-845-3125",
            "fax_number": "951-769-1582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID KLEIS II, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KNIGHT",
        "authorized_official_first_name": "MAE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "951-845-3125",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC55740G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palm Grove Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dara D'Elia
• Daaella Inc
• Dae Won Lee DDS Inc (Beaumont Smile Dental)
• Daniel C. Park DDS Inc
• Dark & Kaibel, D.C.'S
• David Kleis, Inc. (Beaumont Care Center)
• Brittany Davila
• Keiko Davisson, DDS
• Jhanelle Dawes
• Michael Roy De Gasperin, MFT

• Skilled Nursing Facility in Beaumont, CA
• Providers in Beaumont, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.