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19D2112476 CLIA NUMBER - PELICAN PEDIATRIC DAY HEALTH CARE CENTER

Laboratory Demographics

CLIA Number: 19D2112476

Facility Name: PELICAN PEDIATRIC DAY HEALTH CARE CENTER

Facility Address:
400 MARTIN LUTHER KING JR DRIVE, SUITE F
NATCHITOCHES, LA
ZIP 71457
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Facility Phone Number: 318 238-3880

Facility Type: Other - PEDIATRIC DAY HEALTH CARE

Certificate Type: Waiver
NPI Number: 1093172058

Taxonomy: 261QM3000X - Clinic/Center
An entity, facility, or distinct part of a facility specially equipped and staffed to provide care for medically fragile children with varied and complex care needs (e.g., enteral or parental feeding, ostomy care, respiratory/ventilator care, medications and therapies, etc.).

CLIA Record

Field Name Field Value
CLIA Number 19D2112476
LAB Type Other - PEDIATRIC DAY HEALTH CARE
Facility Name PELICAN PEDIATRIC DAY HEALTH CARE CENTER
Street 400 MARTIN LUTHER KING JR DRIVE, SUITE F
City NATCHITOCHES
State LA
ZIP 71457
Phone 318 238-3880
CertificateType 4
CertificateEffectiveDate 4/29/2022
CertificateExpirationDate 4/28/2024
FacilityType Waiver

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This page was last updated on: 4/23/2024