Healthcare Provider Details

I. General information

NPI: 1962481473
Provider Name (Legal Business Name): HQM OF SPRING CITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 HINCH ST
SPRING CITY TN
37381-5217
US

IV. Provider business mailing address

331 HINCH ST
SPRING CITY TN
37381-5217
US

V. Phone/Fax

Practice location:
  • Phone: 423-365-4355
  • Fax:
Mailing address:
  • Phone: 423-365-4355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0000000210
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0210
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0445209
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer
# 2
Identifier7440512
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer

VIII. Authorized Official

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