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NPI Code Detail

MEDICARE: HQM OF MEADOWS SOUTH, LLC

MEDICARE: HQM OF MEADOWS SOUTH, 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
1314000000XSkilled Nursing Facility100452KY

Other Identifiers

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

General Provider Information

NPI Number : 1437139136
Entity Type Code : Organization
Provider Name (Legal Business Name) : HQM OF MEADOWS SOUTH, LLC
Provider Business Mailing Address
First Line : 2979 PGA BLVD
Second Line :
City : PALM BEACH GARDENS
State : FL
Zip : 33410-2911
Country : US
Telephone Number : 561-627-0664
Fax Number : 561-627-2867
Provider Business Practice Location Address
First Line : 1120 CRISTLAND RD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40214-4150
Country : US
Telephone Number : 502-367-0104
Fax Number :
Authorized Official
Title or Position : CEO
Name : MR. PAUL WALCZAK
Credential :
Telephone Number : 561-627-0664
Provider Enumeration Date : 01/19/2006
Last Update Date : 08/22/2020

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