MEDICARE: HQM OF BEATTYVILLE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility		KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124054648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HQM OF BEATTYVILLE, LLC

Provider Business Mailing Address
First Line	:	249 E MAIN ST
Second Line	:
City	:	BEATTYVILLE
State	:	KY
Zip	:	41311-9249
Country	:	US
Telephone Number	:	606-464-3611
Fax Number	:

Provider Business Practice Location Address
First Line	:	249 E MAIN ST
Second Line	:
City	:	BEATTYVILLE
State	:	KY
Zip	:	41311-9249
Country	:	US
Telephone Number	:	606-464-3611
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. PAUL WALCZAK
Credential	:
Telephone Number	:	561-627-0664

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	08/22/2020

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