Healthcare Provider Details

I. General information

NPI: 1154357549
Provider Name (Legal Business Name): HQM OF TARPON SPRINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 BECKETT WAY
TARPON SPRINGS FL
34689-5709
US

IV. Provider business mailing address

900 BECKETT WAY
TARPON SPRINGS FL
34689-5709
US

V. Phone/Fax

Practice location:
  • Phone: 727-934-0876
  • Fax:
Mailing address:
  • Phone: 727-934-0876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. PAUL WALCZAK
Title or Position: CEO
Credential:
Phone: 561-627-0664