Provider Demographics
NPI:1568695617
Name:FALCON SOUTH PLAINS HOSPICE, LP
Entity Type:Organization
Organization Name:FALCON SOUTH PLAINS HOSPICE, LP
Other - Org Name:INTERIM HOSPICE OF PERMIAN BASIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MARKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:806-771-0995
Mailing Address - Street 1:3223 S LOOP 289 STE 210
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1352
Mailing Address - Country:US
Mailing Address - Phone:806-771-0995
Mailing Address - Fax:806-771-3813
Practice Address - Street 1:1031 ANDREWS HWY STE 100
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-3873
Practice Address - Country:US
Practice Address - Phone:432-550-7593
Practice Address - Fax:432-618-0307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012962251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001019898Medicaid
45D2185345OtherCLIA
TX012962OtherSTATE OPERATOR LICENSE