Provider Demographics
NPI:1922669183
Name:PELICAN STATE HOME AND COMMUNITY SERVICES
Entity Type:Organization
Organization Name:PELICAN STATE HOME AND COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISHONDRA
Authorized Official - Middle Name:ANDRELL
Authorized Official - Last Name:NOEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-601-1581
Mailing Address - Street 1:7552 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4218
Mailing Address - Country:US
Mailing Address - Phone:985-852-6586
Mailing Address - Fax:888-765-1319
Practice Address - Street 1:7552 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4218
Practice Address - Country:US
Practice Address - Phone:985-852-6586
Practice Address - Fax:888-765-1319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-27
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty