- Enrollment id
- O20230828003783
- Enrollment state
- TX
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1649961582
- Multiple npi flag
- N
- Ccn
- A91768
- Associate id
- 7911360680
- Organization name
- PELICAN HOSPICE LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1140 EMPIRE CENTRAL DR
- Address line 2
- STE 655
- City
- DALLAS
- State
- TX
- Zip code
- 752474322