Provider Demographics
NPI:1285614982
Name:HQM OF MEADOWS EAST, LLC
Entity type:Organization
Organization Name:HQM OF MEADOWS EAST, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:WALCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-162-7066
Mailing Address - Street 1:2529 SIX MILE LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-2934
Mailing Address - Country:US
Mailing Address - Phone:502-491-5560
Mailing Address - Fax:
Practice Address - Street 1:2529 SIX MILE LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-2934
Practice Address - Country:US
Practice Address - Phone:502-491-5560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100428314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12504254Medicaid
KY18-5350Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER