# MESA GLEN HOLDINGS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mesa Glen Care Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932215100
- **Authorized official:** MS. JENNIFER GREENWELL (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (909) 987-7735

## Contact information

- **Practice address:** 638 E COLORADO AVE, GLENDORA, CA 91740
- **Practice address phone:** (626) 963-6091
- **Practice address fax:** (626) 963-0653
- **Mailing address:** 16742 ORANGE WAY, FONTANA, CA 92335-3809
- **Mailing address phone:** (909) 987-7735
- **Mailing address fax:** (909) 484-6809

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 950000026 | CA | Yes |

## Other

- **Enumeration date:** 08/21/2006
- **Last updated:** 08/19/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZT05676G | — | CA |