Healthcare Provider Details

I. General information

NPI: 1902462401
Provider Name (Legal Business Name): PELICAN HEALTH HENDERSON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 S BECKFORD DR
HENDERSON NC
27536-2564
US

IV. Provider business mailing address

980 SYLVAN AVE
ENGLEWOOD CLIFFS NJ
07632-3315
US

V. Phone/Fax

Practice location:
  • Phone: 252-438-6141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: BATYA GORELICK
Title or Position: VP OF ADMINISTRATIVE SERVICES
Credential:
Phone: 252-438-6141