Healthcare Provider Details

I. General information

NPI: 1962277822
Provider Name (Legal Business Name): QUALITY LIFE SERVICES - APOLLO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 GOODVIEW DR
APOLLO PA
15613-8527
US

IV. Provider business mailing address

612 N MAIN ST
BUTLER PA
16001-4363
US

V. Phone/Fax

Practice location:
  • Phone: 724-727-3451
  • Fax:
Mailing address:
  • Phone: 724-431-0770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: STEVEN D. TACK
Title or Position: PRESIDENT/CEO
Credential:
Phone: 724-431-0770