MEDICARE: QUALITY LIFE SERVICES - MERCER, 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

General Provider Information

NPI Number	:	1669247409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY LIFE SERVICES - MERCER, LLC

Provider Business Mailing Address
First Line	:	612 N MAIN ST
Second Line	:
City	:	BUTLER
State	:	PA
Zip	:	16001-4363
Country	:	US
Telephone Number	:	724-431-0770
Fax Number	:

Provider Business Practice Location Address
First Line	:	8221 LAMOR RD
Second Line	:
City	:	MERCER
State	:	PA
Zip	:	16137-3163
Country	:	US
Telephone Number	:	724-662-5860
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	STEVEN D. TACK
Credential	:
Telephone Number	:	724-431-0770

Provider Enumeration Date	:	11/21/2023
Last Update Date	:	11/21/2023

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