Healthcare Provider Details

I. General information

NPI: 1598628331
Provider Name (Legal Business Name): PELICAN HARBOUR ASSISTED LIVING II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 SANTA ROSA DR
ROCKLEDGE FL
32955-2117
US

IV. Provider business mailing address

1115 SANTA ROSA DR
ROCKLEDGE FL
32955-2117
US

V. Phone/Fax

Practice location:
  • Phone: 321-481-0800
  • Fax: 321-481-0800
Mailing address:
  • Phone: 321-481-0800
  • Fax: 321-481-0800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: CONSTANCE COLES
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 321-481-0800