Healthcare Provider Details

I. General information

NPI: 1942280649
Provider Name (Legal Business Name): HQM OF RIDGELY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 MAIN STREET
RIDGELY TN
38080
US

IV. Provider business mailing address

117 MAIN STREET
RIDGELY TN
38080
US

V. Phone/Fax

Practice location:
  • Phone: 731-264-5555
  • Fax:
Mailing address:
  • Phone: 731-264-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0152
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0152
License Number StateTN

VIII. Authorized Official

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