Provider Demographics
NPI:1508372475
Name:FL FALCON HOME CARE LLC
Entity Type:Organization
Organization Name:FL FALCON HOME CARE LLC
Other - Org Name:FL FALCON HOME CARE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WAVENEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:813-446-0162
Mailing Address - Street 1:3706 W IDLEWILD CIR APT 203
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-5754
Mailing Address - Country:US
Mailing Address - Phone:800-557-3173
Mailing Address - Fax:813-348-2993
Practice Address - Street 1:3706 W IDLEWILD CIR APT 203
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-5754
Practice Address - Country:US
Practice Address - Phone:800-557-3173
Practice Address - Fax:813-348-2993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-14
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL234950253Z00000X, 311500000X, 372600000X, 376J00000X
FL385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive Care
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)Group - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty