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General NPI Number Information
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NPI Number | 1861767832
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Entity Type | Organization
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Legal Business Name | PELICAN ASSISTED LIVING LLC
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Dates
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Enumeration Date | 03/09/2012
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 2501 S MAJOR DR
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City | BEAUMONT
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State | TX
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Zip | 77707-5018
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Country | US
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Telephone | 409-860-3500
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Fax | 409-962-9253
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Provider Business Mailing Address
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Address Line | 4500 MAIN AVE
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City | GROVES
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State | TX
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Zip | 77619-4712
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Country | US
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Telephone | 409-962-4450
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Fax | 409-962-9253
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAMES W. MOORE SR.
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Credential |
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Telephone | 409-962-4450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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