Organization
HQM OF SURREY PLACE, LLC
Active
Other names
Surrey Place Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL WALCZAK (CEO)
(561) 627-0664
Entity
Organization
Contact information
Practice address
110 LEE AVE SE, LIVE OAK, FL 32064-9504
(386) 364-5961
Mailing address
110 LEE AVE SE, LIVE OAK, FL 32064-9504
(386) 364-5961
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF1540096
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025710900
—
FL
Enumeration date
01/12/2006
Last updated
02/24/2009
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