MEDICARE: HQM OF TRIMBLE COUNTY, INC.

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	100506	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	:	1629057138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HQM OF TRIMBLE COUNTY, INC.

Provider Business Mailing Address
First Line	:	50 SHEPHERD LN
Second Line	:	TRIMBLE COUNTY
City	:	BEDFORD
State	:	KY
Zip	:	40006-8809
Country	:	US
Telephone Number	:	502-255-3244
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 SHEPHERD LN
Second Line	:	TRIMBLE COUNTY
City	:	BEDFORD
State	:	KY
Zip	:	40006-8809
Country	:	US
Telephone Number	:	502-255-3244
Fax Number	:

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	02/24/2009

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