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General NPI Number Information
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NPI Number | 1093022980
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Entity Type | Organization
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Legal Business Name | PELICAN HAVEN,LLC
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Dates
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Enumeration Date | 09/13/2010
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Last Update Date | 09/13/2010
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Provider Practice Location Address
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Address Line | 4310 14TH ST SW
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City | LEHIGH ACRES
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State | FL
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Zip | 33976-2731
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Country | US
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Telephone | 239-674-7051
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Fax |
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Provider Business Mailing Address
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Address Line | 4310 14TH ST SW
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City | LEHIGH ACRES
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State | FL
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Zip | 33976-2731
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | YVONNE JULMEUS
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Credential |
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Telephone | 239-872-0718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 001926400
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 089390
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License Number State | FL
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