NPIMap

Organization Active NPI

Mesa Glen Holdings LLC

  • Skilled Nursing Facility
  • Glendora, CA
National Provider Identifier
1932215100
Registry record updated Aug 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
950000026 Issued in CA
Legal business name
MESA GLEN HOLDINGS LLC
Practice address
638 E Colorado Ave
Glendora, CA 91740
Phone
(626) 963-6091
Fax
(626) 963-0653
NPI assigned
Aug 21, 2006
Last updated
Aug 19, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Jennifer Greenwell
Title
Chief Financial Officer
Phone
(909) 987-7735

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 950000026 CA Primary

Addresses

Primary practice location

638 E Colorado Ave
Glendora, CA 91740

Mailing address

16742 Orange Way
Fontana, CA 92335-3809
Phone (909) 987-7735

Other identifiers 1

IdentifierTypeStateIssuer
ZZT05676GMedicaidCA

Other names 1

  • Mesa Glen Care Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080804000350 CA Part A Provider - Skilled Nursing Facility 5496829822 Practice locations: Glendora, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1932215100. Details of each certification follow.

Skilled nursing facility certification: CCN 555854

Legal name
MESA GLEN HOLDINGS LLC
Doing business as
MESA GLEN CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 7, 2008
Last certification
Mar 7, 2025
Beds
96
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Renew Health Consulting Services
Organization structure
LLCProprietary
Enrollment address
638 E Colorado Ave
Glendora, CA 91740-4422
Nursing home name
MESA GLEN CARE CENTER

Care Compare: Nursing home

Medicare Care Compare
Listed as
Mesa Glen Care CenterCCN 555854 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
2 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Nov 7, 2008
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9688.1 residents per day on average
Special focus status
SFF Candidate
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
3Fines totaling $103,080

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0963450Mesa Glen Care Center638 East Colorado Blvd, Glendora, CA 91740Certificate of waiverJul 28, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
David Zeffren Individual 5% Or Greater Direct Ownership Interest Feb 6, 2023 19%
Alter M Levitin Individual 5% Or Greater Direct Ownership Interest Feb 6, 2023 19%
Ma Rowena Tolentino Individual Operational/Managerial Control Oct 7, 2024
Adp of the SNF Oct 7, 2024
Diana Wolmark Individual 5% Or Greater Direct Ownership Interest Feb 6, 2023 19%
Hadassah E Weiss Individual 5% Or Greater Direct Ownership Interest Feb 6, 2023 9%
Renew Health Consulting Services LLC Organization, Monrovia, CA LLC, Management services company, For-profit Operational/Managerial Control Feb 6, 2023
Adp of the SNF Feb 6, 2023
Christian Urbina Individual Operational/Managerial Control Jan 27, 2025
Managing Control - Governing BodyAdministrator Jan 27, 2025
Adp of the SNF Jan 27, 2025
Martin J Weiss Individual 5% Or Greater Direct Ownership Interest Feb 6, 2023 9%
Philip Weinberger Individual 5% Or Greater Direct Ownership Interest Jul 4, 2008 10%
Managing Control - Governing BodyManager Feb 6, 2023
Marylynn Mahan Individual 5% Or Greater Direct Ownership Interest Jul 4, 2008 10%
Jose Fernando Velasquez Individual Operational/Managerial Control Feb 1, 2025
Adp of the SNF Feb 1, 2025
Vatsala Sharma Individual Operational/Managerial Control Feb 6, 2023
Adp of the SNF Feb 6, 2023
Gateways Rehabilitation Center II LLC Organization, Simi Valley, CA LLC Adp of the SNF Feb 6, 2023
Bernard Friedman Individual 5% Or Greater Direct Ownership Interest Feb 6, 2023 5%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 13

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 13

Practitioners & affiliated clinicians

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439942400000",
    "number": "1932215100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16742 ORANGE WAY",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923353809",
            "telephone_number": "909-987-7735",
            "fax_number": "909-484-6809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "638 E COLORADO AVE",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "91740",
            "telephone_number": "626-963-6091",
            "fax_number": "626-963-0653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MESA GLEN HOLDINGS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-21",
        "last_updated": "2015-08-19",
        "status": "A",
        "authorized_official_last_name": "GREENWELL",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "909-987-7735",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "950000026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT05676G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mesa Glen Care Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Glendora, CA

Sources for this page

Verify at the official NPI Registry.