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General NPI Number Information
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NPI Number | 1093172058
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Entity Type | Organization
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Legal Business Name | PELICAN PEDIATRIC DAY HEALTH CARE CENTER, LLC
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Dates
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Enumeration Date | 01/21/2016
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Last Update Date | 03/28/2017
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Provider Practice Location Address
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Address Line | 400 MARTIN LUTHER KING JR DR SUITE F
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City | NATCHITOCHES
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State | LA
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Zip | 71457-4056
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Country | US
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Telephone | 318-238-3880
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Fax |
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Provider Business Mailing Address
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Address Line | 108 COMANCHE TRL
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City | WEST MONROE
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State | LA
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Zip | 71291-8106
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Country | US
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Telephone | 318-372-9023
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Fax |
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Authorized Official
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Title or Position | OWNER/COO
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Name | MRS. MELISSA HALL
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Credential | R.N.
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Telephone | 318-238-3880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM3000X
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Taxonomy Name | Medically Fragile Infants and Children Day Care
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License Number |
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License Number State | LA
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