Provider Demographics
NPI:1629200993
Name:FALLBROOK HOME CARE SERVICES, LLC
Entity Type:Organization
Organization Name:FALLBROOK HOME CARE SERVICES, LLC
Other - Org Name:FALLBROOK HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, BUSINESS OFFICE SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:521 E ELDER ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-3081
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:521 E ELDER ST
Practice Address - Street 2:SUITE 208
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3081
Practice Address - Country:US
Practice Address - Phone:760-728-1435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-19
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
051575Medicare PIN