Healthcare Provider Details

I. General information

NPI: 1780190892
Provider Name (Legal Business Name): QLS MONONGAHELA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2017
Last Update Date: 12/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1277 COUNTRY CLUB RD
MONONGAHELA PA
15063-1057
US

IV. Provider business mailing address

612 N MAIN ST
BUTLER PA
16001-4363
US

V. Phone/Fax

Practice location:
  • Phone: 724-431-0770
  • 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: DEAN RIPPEE
Title or Position: CFO
Credential:
Phone: 724-431-0770