| NPI | 1316449671 |
|---|---|
| Former Legal Business Name | PELICAN BAYOU |
| Entity Type | Organization |
| Authorized Contact | RHONDA YOUNG Mhp 516-633-8891 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251B00000X Case Management (Licence: LA 1760852511) |
| Enumeration Date | 2018-03-02 |
| Last Update Date | 2018-03-02 |