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General NPI Number Information
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NPI Number | 1225017791
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Entity Type | Organization
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Legal Business Name | HQM OF GREENEVILLE WEST, LLC
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Dates
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Enumeration Date | 01/12/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 106 HOLT CT
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City | GREENEVILLE
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State | TN
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Zip | 37743-6917
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Country | US
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Telephone | 423-639-0213
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Fax |
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Provider Business Mailing Address
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Address Line | 106 HOLT CT
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City | GREENEVILLE
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State | TN
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Zip | 37743-6917
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Country | US
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Telephone | 423-639-0213
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. PAUL WALCZAK
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Credential |
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Telephone | 561-627-0664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 00995
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 0995
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License Number State | TN
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