Provider Demographics
NPI:1093172058
Name:PELICAN PEDIATRIC DAY HEALTH CARE CENTER, LLC
Entity Type:Organization
Organization Name:PELICAN PEDIATRIC DAY HEALTH CARE CENTER, LLC
Other - Org Name:PELICAN PEDIATRIC DAY HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:318-238-3880
Mailing Address - Street 1:108 COMANCHE TRL
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-8106
Mailing Address - Country:US
Mailing Address - Phone:318-372-9023
Mailing Address - Fax:
Practice Address - Street 1:400 MARTIN LUTHER KING JR DR
Practice Address - Street 2:SUITE F
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-4056
Practice Address - Country:US
Practice Address - Phone:318-238-3880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QM3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care