Provider Demographics
NPI:1760462477
Name:HQM OF LAURELWOOD, LLC
Entity Type:Organization
Organization Name:HQM OF LAURELWOOD, LLC
Other - Org Name:LAURELWOOD CARE CENTER AT ELKTON
Other - Org Type:Doing Business As
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:561-627-0664
Mailing Address - Street 1:100 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5328
Mailing Address - Country:US
Mailing Address - Phone:410-398-8800
Mailing Address - Fax:
Practice Address - Street 1:100 LAUREL DR
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5328
Practice Address - Country:US
Practice Address - Phone:410-398-8800
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
MD07003314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21-5111Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER