Organization
HQM OF PINE RIDGE, LLC
Active
Other names
Pine Ridge Care & Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL WALCZAK (CEO)
(561) 627-0664
Entity
Organization
Contact information
Practice address
1200 SPRUCE LN, CARTER COUNTY, ELIZABETHTON, TN 37643-4301
(423) 543-3202
Mailing address
1200 SPRUCE LN, CARTER COUNTY, ELIZABETHTON, TN 37643-4301
(423) 543-3202
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
0027
TN
314000000X
Skilled Nursing Facility
0027
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0445217
—
TN
05
—
7440568
—
TN
Enumeration date
01/12/2006
Last updated
09/11/2025
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