HQM of Charlestown, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

HQM OF CHARLESTOWN, LLC

Practice address

1263 S George St
Charles Town, WV 25414-4384

Phone

(304) 725-6575

NPI assigned

Jul 8, 2006

Organization subpart

No

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

Addresses

Other identifiers 1

Other names 1

• Blue Ridge Care & Rehabilitation Center Doing business as

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1528091055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1263 S GEORGE ST",
            "city": "CHARLES TOWN",
            "state": "WV",
            "postal_code": "254144384",
            "telephone_number": "304-725-6575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1263 S GEORGE ST",
            "city": "CHARLES TOWN",
            "state": "WV",
            "postal_code": "254144384",
            "telephone_number": "304-725-6575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HQM OF CHARLESTOWN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2020-08-22",
        "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": "WV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1001000-000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Ridge Care & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Susan Kae Hippchen
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• Colleen NMN Imbraglio
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• Ronald Jan Jackson III
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• All providers in Charles Town, WV
• Skilled Nursing Facility in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.