Healthcare Provider Details

I. General information

NPI: 1487136479
Provider Name (Legal Business Name): LA MESA POST ACUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 LA MESA DR
ALTA LOMA CA
91701-5805
US

IV. Provider business mailing address

107 W LEMON AVE
MONROVIA CA
91016-2809
US

V. Phone/Fax

Practice location:
  • Phone: 909-987-2501
  • Fax: 909-987-0282
Mailing address:
  • Phone: 323-836-9397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number240000105
License Number StateCA

VIII. Authorized Official

Name: CRYSTAL SOLORZANO
Title or Position: MANAGER
Credential:
Phone: 323-836-9397