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General NPI Number Information
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NPI Number | 1396778825
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Entity Type | Organization
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Legal Business Name | HQM OF PORT CHARLOTTE, LLC
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4033 BEAVER LN
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-9206
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Country | US
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Telephone | 941-625-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 4033 BEAVER LN
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-9206
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Country | US
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Telephone |
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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 |
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License Number State | FL
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