MEDICARE: LA MESA POST ACUTE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	240000105	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	555521	OTHER	CA	MEDICARE PROVIDER NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487136479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA MESA POST ACUTE LLC

Provider Business Mailing Address
First Line	:	107 W LEMON AVE
Second Line	:
City	:	MONROVIA
State	:	CA
Zip	:	91016-2809
Country	:	US
Telephone Number	:	323-836-9397
Fax Number	:

Provider Business Practice Location Address
First Line	:	9333 LA MESA DR
Second Line	:
City	:	ALTA LOMA
State	:	CA
Zip	:	91701-5805
Country	:	US
Telephone Number	:	909-987-2501
Fax Number	:	909-987-0282

Authorized Official
Title or Position	:	MANAGER
Name	:	CRYSTAL SOLORZANO
Credential	:
Telephone Number	:	323-836-9397

Provider Enumeration Date	:	09/05/2018
Last Update Date	:	09/05/2018

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Directions to “LA MESA POST ACUTE LLC ” Practice Location

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