Pelican Assisted Living LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

PELICAN ASSISTED LIVING LLC

Doing business as

Pelican Bay

Practice address

2501 S Major Dr
Beaumont, TX 77707-5018

Phone

(409) 860-3500

Fax

(409) 962-9253

NPI assigned

Mar 9, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. James W. Moore Sr.

Title

President

Phone

(409) 962-4450

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pelican Bay Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1331251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1861767832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 MAIN AVE",
            "city": "GROVES",
            "state": "TX",
            "postal_code": "776194712",
            "telephone_number": "409-962-4450",
            "fax_number": "409-962-9253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 S MAJOR DR",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777075018",
            "telephone_number": "409-860-3500",
            "fax_number": "409-962-9253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PELICAN ASSISTED LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-09",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "409-962-4450",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS COMPTROLLER OF PUBLIC ACCOUNTS TAXPAYER NUMBER",
            "identifier": "32044376872",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pelican Bay",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Beaumont, TX
• Providers in Beaumont, TX by specialty
• Assisted Living Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.