# AG LA MESA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Country Manor La Mesa Healthcare Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457345001
- **Authorized official:** MR. JACOB WINTNER (MANAGER)
- **Authorized official phone:** (323) 651-1808

## Contact information

- **Practice address:** 5696 LAKE MURRAY BOULEVARD, LA MESA, CA 91942
- **Practice address phone:** (619) 460-7871
- **Practice address fax:** (619) 460-4810
- **Mailing address:** 5696 LAKE MURRAY BOULEVARD, LA MESA, CA 91942
- **Mailing address phone:** (619) 460-7871
- **Mailing address fax:** (310) 574-1322

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 080000020 | CA | Yes |

## Other

- **Enumeration date:** 09/08/2005
- **Last updated:** 07/21/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZT05910J | — | CA |