Healthcare Provider Details

I. General information

NPI: 1760226633
Provider Name (Legal Business Name): BETHEL PARK SNF HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 HIGHLAND RD
BETHEL PARK PA
15102-1806
US

IV. Provider business mailing address

262 N UNIVERSITY AVE
FARMINGTON UT
84025-2975
US

V. Phone/Fax

Practice location:
  • Phone: 412-831-6050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN MITCHELL
Title or Position: SECRETARY
Credential:
Phone: 385-988-3319