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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