Provider Demographics
NPI:1396189247
Name:PELICAN HEALTHCARE SYSTEM LLC
Entity Type:Organization
Organization Name:PELICAN HEALTHCARE SYSTEM LLC
Other - Org Name:NDANDO HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:ELOKAN
Authorized Official - Last Name:NDANDO-NGOO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:713-292-8739
Mailing Address - Street 1:P.O. BOX 1015
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70602
Mailing Address - Country:US
Mailing Address - Phone:713-292-8739
Mailing Address - Fax:
Practice Address - Street 1:152 OLD SAWMILL ROAD
Practice Address - Street 2:
Practice Address - City:KINDER
Practice Address - State:LA
Practice Address - Zip Code:70648
Practice Address - Country:US
Practice Address - Phone:713-292-8739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health