MEDICARE: PELICAN PEDIATRIC DAY HEALTH CARE CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM3000X	Medically Fragile Infants and Children Day Care		LA

General Provider Information

NPI Number	:	1093172058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PELICAN PEDIATRIC DAY HEALTH CARE CENTER, LLC

Provider Business Mailing Address
First Line	:	108 COMANCHE TRL
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-8106
Country	:	US
Telephone Number	:	318-372-9023
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 MARTIN LUTHER KING JR DR
Second Line	:	SUITE F
City	:	NATCHITOCHES
State	:	LA
Zip	:	71457-4056
Country	:	US
Telephone Number	:	318-238-3880
Fax Number	:

Authorized Official
Title or Position	:	OWNER/COO
Name	:	MRS. MELISSA HALL
Credential	:	R.N.
Telephone Number	:	318-238-3880

Provider Enumeration Date	:	01/21/2016
Last Update Date	:	03/28/2017

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