NPIMap

Organization Active NPI

HQM of Mallard Bay, LLC

Doing business as Mallard Bay Care Center at Cambridge

  • Skilled Nursing Facility
  • Cambridge, MD
National Provider Identifier
1316927023
Registry record updated Feb 24, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
09006 Issued in MD
Legal business name
HQM OF MALLARD BAY, LLC
Doing business as
Mallard Bay Care Center at Cambridge
Practice address
520 Glenburn Ave
Cambridge, MD 21613-1415
Phone
(410) 228-9191
NPI assigned
Jan 19, 2006
Last updated
Feb 24, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Paul Walczak
Title
Ceo
Phone
(561) 627-0664

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 09006 MD Primary

Addresses

Primary practice location

520 Glenburn Ave
Cambridge, MD 21613-1415

Mailing address

520 Glenburn Ave
Cambridge, MD 21613-1415
Phone (410) 228-9191

Other identifiers 1

IdentifierTypeStateIssuer
406320100MedicaidMD

Other names 1

  • Mallard Bay Care Center at Cambridge Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235433600000",
    "number": "1316927023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 GLENBURN AVE",
            "city": "CAMBRIDGE",
            "state": "MD",
            "postal_code": "216131415",
            "telephone_number": "410-228-9191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 GLENBURN AVE",
            "city": "CAMBRIDGE",
            "state": "MD",
            "postal_code": "216131415",
            "telephone_number": "410-228-9191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HQM OF MALLARD BAY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-19",
        "last_updated": "2009-02-24",
        "status": "A",
        "authorized_official_last_name": "WALCZAK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "561-627-0664",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MD",
            "license": "09006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "406320100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mallard Bay Care Center at Cambridge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cambridge, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.