PELICAN ASSISTED LIVING LLC (NPI# 1861767832) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861767832 |
| Entity Type | Organization |
| Organization Name | PELICAN ASSISTED LIVING LLC |
| Other Organization Name | PELICAN BAY |
| Practice Address |
2501 S Major Dr Beaumont TX 77707-5018 |
| Mailing Address |
4500 Main Ave Groves TX 77619-4712 |
| Practice Telephone | 4098603500 |
| Practice Fax Number | 4099629253 |
| Mailing Telephone | 4099624450 |
| Mailing Fax Number | 4099629253 |
| Enumeration Date | 2012-03-09 |
| Last Update Date | 2018-06-20 |
| Authorized Official Name | MR. JAMES W. MOORE SR. (PRESIDENT) |
| Authorized Official Telephone | 4099624450 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | TEXAS COMPTROLLER OF PUBLIC ACCOUNTS TAXPAYER NUMBER | 32044376872 | 01 |
| Other Name | Type Code |
|---|---|
| Pelican Bay | Doing Business As Name - Organization |
| Street Address |
2501 S MAJOR DR |
| City | BEAUMONT |
| State | TX |
| Zip Code | 77707-5018 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437718004 | Kelsey Marie Burt | Speech-Language Pathologist | 87 I-10, Beaumont, TX 77707 | 2019-06-07 |
| 1245898808 | Primary Care Anywhere, Pllc | Nurse Practitioner | 4347 Phelan, Suite 101, Beaumont, TX 77707 | 2019-05-30 |
| 1598321663 | Kacy Keitha Priddy | Occupational Therapist | 1846 I-10 S, Suite 102, Beaumont, TX 77707 | 2019-05-14 |
| 1144791963 | Jeffery Ray Manzer | Counselor | 3350 Dowlen Rd Suite J, Beaumont, TX 77707 | 2018-12-06 |
| 1497247217 | Haley Hebert | Speech-Language Pathologist | 87 I 10 N, Suite 225, Beaumont, TX 77707 | 2018-06-06 |
| 1548712383 | Taylor Miguez | Speech-Language Pathologist | 87 I-10 Frontage Rd #225, Beaumont, TX 77707 | 2016-10-27 |
| 1720534043 | Jacie Woodson | Speech-Language Pathologist | 87 I-10 Frontage Rd. 225, Beaumont, TX 77707 | 2016-08-28 |
| 1285187047 | Paula Boudreaux | Speech-Language Pathologist | 87 I-10 Frontage Rd, Suite 225, Beaumont, TX 77707 | 2016-07-28 |
| 1790138568 | Meagan Alyse Hartwick | Speech-Language Pathologist | 87 I-10 Frontage Rd., 225, Beaumont, TX 77707 | 2016-07-18 |
| 1376992578 | Laurie Lynette Jansky | Family Medicine | 3650 Laurel Ave, Beaumont, TX 77707 | 2016-06-08 |
| Find all providers in zip 77707 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669088373 | A Tender Touch Senior Living LLC | Assisted Living Facility | 1651 Rose Ave, Beaumont, CA 92223-7174 | 2020-09-17 |
| 1306452008 | Amazing Grace Care Services LLC | Assisted Living Facility | 43 Sitara Ave, Beaumont, CA 92223-3110 | 2020-09-17 |
| 1902373749 | Serenity Assisted Care Living, L.L.C. | Assisted Living Facility | 1945 Pennsylvania St, Beaumont, TX 77701-6025 | 2018-10-30 |
| 1811220072 | New Beginning Adult Care | Assisted Living Facility | 2390 Cartwright St, Beaumont, TX 77701-6709 | 2009-09-04 |
| 1881893931 | 625 Orleans Lp | Assisted Living Facility | 625 Orleans St, Beaumont, TX 77701 | 2007-07-17 |
| 1851509632 | Lenrose Place | Assisted Living Facility | 5395 Rose Ln, Beaumont, TX 77708-2911 | 2007-05-18 |
| 1023134608 | Assisted Living Concepts Inc | Assisted Living Facility | 2910 Toccoa Road, Beaumont, TX 77703 | 2007-03-22 |
| 1306140207 | Arv Assisted Living, Inc. | Assisted Living Facility | 4650 Collier St, Beaumont, TX 77706-7078 | 2011-01-06 |
| 1407075476 | Esc Iv, L.p. | Assisted Living Facility | 2250 Dowlen Rd, Beaumont, TX 77706-2586 | 2007-04-25 |
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|---|---|---|---|---|
| 1912507690 | Bolville LLC | Assisted Living Facility | 9898 Bissonnet St Ste 419, Houston, TX 77036-8025 | 2020-10-30 |
| 1548860067 | Zenith Care Inc | Assisted Living Facility | 1513 Baffin Bay Dr, Plano, TX 75075-2203 | 2020-10-26 |
| 1003415712 | Valarie C Williams | Assisted Living Facility | 2019 Greenwest Dr, Missouri City, TX 77489-4043 | 2020-10-23 |
| 1902404791 | Heritage Retreat Management Group, Inc. | Assisted Living Facility | 7105 Hot Creek Trce, Humble, TX 77346-3098 | 2020-10-13 |
| 1255939104 | Rance Carrington | Assisted Living Facility | 1137 W California St, Seymour, TX 76380-1552 | 2020-10-13 |
| 1083212211 | Neighbors Care, LLC | Assisted Living Facility | 3906 Everett Terrace Ln, Missouri City, TX 77459-1888 | 2020-10-10 |
| 1598362840 | Golden Age Home Care | Assisted Living Facility | 12706 Mutiny Ln, Tomball, TX 77377-8420 | 2020-10-08 |
| 1164038253 | Residential Senior Care (rsc) | Assisted Living Facility | 8040 Honeywood Trial, Port Arthur, TX 77642 | 2020-09-23 |
| 1548874670 | A Compassionate Assisted Living LLC | Assisted Living Facility | 1008 Springbrook Dr, Desoto, TX 75115-3944 | 2020-09-04 |
| 1679187975 | Arc Willowbrook, LLC | Assisted Living Facility | 7450 Willow Chase Blvd, Houston, TX 77070-5867 | 2020-09-03 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.