QLS Jefferson LP

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

QLS JEFFERSON LP

Practice address

540 Coal Valley Rd
Jefferson Hills, PA 15025-3704

Phone

(412) 466-1125

Fax

(412) 466-1971

NPI assigned

Sep 24, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Steven D Tack

Title

Ceo

Phone

(724) 431-0770

Specialties & licenses 1

Addresses

Other names 1

• Quality Life Services - Jefferson Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1537747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537747200000",
    "number": "1285118331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 N MAIN ST",
            "city": "BUTLER",
            "state": "PA",
            "postal_code": "160014363",
            "telephone_number": "724-431-0770",
            "fax_number": "724-284-3712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 COAL VALLEY RD",
            "city": "JEFFERSON HILLS",
            "state": "PA",
            "postal_code": "150253704",
            "telephone_number": "412-466-1125",
            "fax_number": "412-466-1971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QLS JEFFERSON LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-24",
        "last_updated": "2018-09-24",
        "status": "A",
        "authorized_official_last_name": "TACK",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "724-431-0770",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Quality Life Services - Jefferson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Primary Care Group 8, Inc.
• Mandy Proud, CRNA
• Courtney Pryor, CRNP
• Amberlyn Pucel, CRNP
• Frances Pucharich
• Derrico Vincent Quattrone, DPM
• Christopher A Radkowski, M.D.
• Riaz Riza Rahman
• Kristi Lynn Rain-Jaras, MD
• Jethalal L Rambhia, M.D.

• All providers in Jefferson Hills, PA
• Skilled Nursing Facility in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.