MEDICARE: FALCON LAKE HEALTH CARE, LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	313M00000X	Nursing Facility/Intermediate Care Facility	005353	TX

General Provider Information

NPI Number	:	1447283221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FALCON LAKE HEALTH CARE, LTD.

Provider Business Mailing Address
First Line	:	1434 STOP14B
Second Line	:	200 CARLA
City	:	ZAPATA
State	:	TX
Zip	:	78076-2812
Country	:	US
Telephone Number	:	956-765-3040
Fax Number	:

Provider Business Practice Location Address
First Line	:	1434 STOP14B
Second Line	:	200 CARLA
City	:	ZAPATA
State	:	TX
Zip	:	78076-2812
Country	:	US
Telephone Number	:	956-765-3040
Fax Number	:

Authorized Official
Title or Position	:	SEC./TREASURER -GENERAL PARTNER
Name	:	MR. JAGDISH C. GUPTA
Credential	:
Telephone Number	:	337-652-0755

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	08/22/2020

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