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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