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Organization
MESA GLEN HOLDINGS LLC
Active
Organization
MESA GLEN HOLDINGS LLC
Active
Other names
Mesa Glen Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JENNIFER GREENWELL (CHIEF FINANCIAL OFFICER)
(909) 987-7735
Entity
Organization
Contact information
Practice address
638 E COLORADO AVE, GLENDORA, CA 91740
(626) 963-6091
(626) 963-0653
Mailing address
16742 ORANGE WAY, FONTANA, CA 92335-3809
(909) 987-7735
(909) 484-6809
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
950000026
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZT05676G
—
CA
Enumeration date
08/21/2006
Last updated
08/19/2015
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