# COMMUNITY CONVALESCENT HOSPITAL OF LA MESA LP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225028327
- **Authorized official:** MR. JACOB GRAFF (PRESIDENT)
- **Authorized official phone:** (323) 556-0040

## Contact information

- **Practice address:** 8665 LA MESA BLVD, LA MESA, CA 91941
- **Practice address phone:** (619) 465-0702
- **Practice address fax:** (619) 828-1782
- **Mailing address:** 8665 LA MESA BLVD, LA MESA, CA 91941-3903
- **Mailing address phone:** (619) 465-0702
- **Mailing address fax:** (619) 828-1782

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 090000033 | CA | Yes |

## Other

- **Enumeration date:** 10/28/2005
- **Last updated:** 07/25/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZT18070G | — | CA |