Provider Demographics
NPI:1952519688
Name:FALCON LAKE HEALTH CARE, LTD
Entity Type:Organization
Organization Name:FALCON LAKE HEALTH CARE, LTD
Other - Org Name:FALCON LAKE NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-765-3040
Mailing Address - Street 1:1434 STOP14B
Mailing Address - Street 2:
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 1:200 CARLA STREET
Practice Address - Street 2:
Practice Address - City:ZAPATA
Practice Address - State:TX
Practice Address - Zip Code:78076
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:2007-05-18
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001013854Medicaid