Provider Demographics
NPI:1447283221
Name:FALCON LAKE HEALTH CARE, LTD.
Entity type:Organization
Organization Name:FALCON LAKE HEALTH CARE, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SEC./TREASURER -GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAGDISH
Authorized Official - Middle Name:C
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-652-0755
Mailing Address - Street 1:1434 STOP14B
Mailing Address - Street 2:200 CARLA
Mailing Address - City:ZAPATA
Mailing Address - State:TX
Mailing Address - Zip Code:78076-2812
Mailing Address - Country:US
Mailing Address - Phone:956-765-3040
Mailing Address - Fax:
Practice Address - Street 1:1434 STOP14B
Practice Address - Street 2:200 CARLA
Practice Address - City:ZAPATA
Practice Address - State:TX
Practice Address - Zip Code:78076-2812
Practice Address - Country:US
Practice Address - Phone:956-765-3040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX005353313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility