Provider Demographics
NPI:1518076629
Name:PELICAN HEALTHCARE INC
Entity Type:Organization
Organization Name:PELICAN HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LETHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-652-4136
Mailing Address - Street 1:948 CAMBRIDGE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-3647
Mailing Address - Country:US
Mailing Address - Phone:985-652-7717
Mailing Address - Fax:985-618-3611
Practice Address - Street 1:948 CAMBRIDGE DR STE 102
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3647
Practice Address - Country:US
Practice Address - Phone:985-652-7717
Practice Address - Fax:985-652-4137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2138910OtherMEDICARE
LA884314700Medicaid