Provider Demographics
NPI:1053754606
Name:PELICAN REHABILITATION HOSPITAL, LLC
Entity type:Organization
Organization Name:PELICAN REHABILITATION HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SYBIL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-341-9351
Mailing Address - Street 1:41191 CITADEL DR
Mailing Address - Street 2:
Mailing Address - City:SORRENTO
Mailing Address - State:LA
Mailing Address - Zip Code:70778-3425
Mailing Address - Country:US
Mailing Address - Phone:225-341-9351
Mailing Address - Fax:225-644-8341
Practice Address - Street 1:4201 WOODLAND DR
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-7339
Practice Address - Country:US
Practice Address - Phone:504-378-5060
Practice Address - Fax:504-378-5061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-14
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital