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General NPI Number Information
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NPI Number | 1720274160
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Entity Type | Organization
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Legal Business Name | LEA,LLC
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 09/19/2007
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Provider Practice Location Address
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Address Line | 1378 4TH ST
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City | MONONGAHELA
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State | PA
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Zip | 15063-1201
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Country | US
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Telephone | 724-258-8248
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Fax | 724-258-8259
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Provider Business Mailing Address
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Address Line | 1378 4TH ST
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City | MONONGAHELA
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State | PA
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Zip | 15063-1201
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Country | US
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Telephone | 724-258-8248
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Fax | 724-258-8259
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. AMBER LANAE CRAWFORD
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Credential |
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Telephone | 724-258-8248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 418660
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License Number State | PA
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