1144525700 NPI number — FALCON SOUTH PLAINS HOSPICE, LP

Table of content: (NPI 1144525700)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144525700 NPI number — FALCON SOUTH PLAINS HOSPICE, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FALCON SOUTH PLAINS HOSPICE, LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
INTERIM HOSPICE OF GRANBURY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144525700
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3223 S LOOP 289 STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79423-1352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-771-0995
Provider Business Mailing Address Fax Number:
806-771-3813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6801 SANGER AVE STE 260
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WACO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76710-7803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-741-6570
Provider Business Practice Location Address Fax Number:
254-751-9390
Provider Enumeration Date:
01/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MARKER
Authorized Official First Name:
SHELLY
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
806-771-0995

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 014809 . This is a "STATE OPERATOR LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 45D2185345 . This is a "CLIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001026114 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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