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Organization
AG LA MESA, LLC
Active
Organization
AG LA MESA, LLC
Active
Other names
Country Manor La Mesa Healthcare Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACOB WINTNER (MANAGER)
(323) 651-1808
Entity
Organization
Contact information
Practice address
5696 LAKE MURRAY BOULEVARD, LA MESA, CA 91942
(619) 460-7871
(619) 460-4810
Mailing address
5696 LAKE MURRAY BOULEVARD, LA MESA, CA 91942
(619) 460-7871
(310) 574-1322
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
080000020
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZT05910J
—
CA
Enumeration date
09/08/2005
Last updated
07/21/2014
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