Provider Demographics
NPI:1922534304
Name:THE PELICAN HEALTHCARE INC
Entity Type:Organization
Organization Name:THE PELICAN HEALTHCARE INC
Other - Org Name:THE PELICAN HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-333-5979
Mailing Address - Street 1:7095 HOLLYWOOD BLVD
Mailing Address - Street 2:539
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-8903
Mailing Address - Country:US
Mailing Address - Phone:424-333-5979
Mailing Address - Fax:213-402-5751
Practice Address - Street 1:7095 HOLLYWOOD BLVD
Practice Address - Street 2:539
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-8903
Practice Address - Country:US
Practice Address - Phone:424-333-5979
Practice Address - Fax:213-402-5751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health