Provider Demographics
NPI:1174866297
Name:FALCON HEALTH CENTER LLC
Entity type:Organization
Organization Name:FALCON HEALTH CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:BORTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-354-8860
Mailing Address - Street 1:WOOD COUNTY HOSPITAL
Mailing Address - Street 2:950 WEST WOOSTER
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402
Mailing Address - Country:US
Mailing Address - Phone:419-372-7443
Mailing Address - Fax:419-372-7999
Practice Address - Street 1:838 E WOOSTER ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-3186
Practice Address - Country:US
Practice Address - Phone:419-372-7443
Practice Address - Fax:419-372-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH0223144003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0085424Medicaid
2140134OtherPK