Provider Demographics
NPI:1114480233
Name:PELICAN HEALTH AT CHARLOTTE LLC
Entity Type:Organization
Organization Name:PELICAN HEALTH AT CHARLOTTE LLC
Other - Org Name:EASTOVER NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF ADMINISTRATIVE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:BATYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORELICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-333-5165
Mailing Address - Street 1:2616 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-4343
Mailing Address - Country:US
Mailing Address - Phone:704-333-5165
Mailing Address - Fax:
Practice Address - Street 1:2616 E 5TH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-4343
Practice Address - Country:US
Practice Address - Phone:704-333-5165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-08
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No385H00000XRespite Care FacilityRespite Care