Healthcare Provider Details

I. General information

NPI: 1447283221
Provider Name (Legal Business Name): FALCON LAKE HEALTH CARE, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1434 STOP14B 200 CARLA
ZAPATA TX
78076-2812
US

IV. Provider business mailing address

1434 STOP14B 200 CARLA
ZAPATA TX
78076-2812
US

V. Phone/Fax

Practice location:
  • Phone: 956-765-3040
  • Fax:
Mailing address:
  • Phone: 956-765-3040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number005353
License Number StateTX

VIII. Authorized Official

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