MEDICARE: MT. LEBANON OPERATIONS 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	:	1134662489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MT. LEBANON OPERATIONS LLC

Provider Business Mailing Address
First Line	:	350 OLD GILKESON RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15228-1063
Country	:	US
Telephone Number	:	412-257-4444
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 OLD GILKESON RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15228-1063
Country	:	US
Telephone Number	:	412-257-4444
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. SUSAN GILBERT
Credential	:
Telephone Number	:	412-257-4444

Provider Enumeration Date	:	11/18/2016
Last Update Date	:	06/10/2019

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