# HQM OF CHARLESTOWN, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Blue Ridge Care & Rehabilitation Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528091055
- **Authorized official:** MR. PAUL WALCZAK (CEO)
- **Authorized official phone:** (561) 627-0664

## Contact information

- **Practice address:** 1263 S GEORGE ST, CHARLES TOWN, WV 25414-4384
- **Practice address phone:** (304) 725-6575
- **Mailing address:** 1263 S GEORGE ST, CHARLES TOWN, WV 25414-4384
- **Mailing address phone:** (304) 725-6575

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | WV | Yes |

## Other

- **Enumeration date:** 07/08/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1001000-000 | — | WV |