Provider Demographics
NPI:1669658415
Name:PELICAN BAY HEARING CARE, INC.
Entity Type:Organization
Organization Name:PELICAN BAY HEARING CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:IRENA
Authorized Official - Middle Name:R
Authorized Official - Last Name:RDZANEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-566-2727
Mailing Address - Street 1:5600 TRAIL BLVD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-2880
Mailing Address - Country:US
Mailing Address - Phone:239-566-2727
Mailing Address - Fax:239-463-7149
Practice Address - Street 1:5600 TRAIL BLVD
Practice Address - Street 2:SUITE 16
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-2880
Practice Address - Country:US
Practice Address - Phone:239-566-2727
Practice Address - Fax:239-463-7149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY 77231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty