Provider Demographics
NPI:1962266163
Name:PELLEGRIN HEALTHCARE LLC
Entity type:Organization
Organization Name:PELLEGRIN HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GUSTAFSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:262-359-0044
Mailing Address - Street 1:12627 HIGHWAY 1078
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:LA
Mailing Address - Zip Code:70437-3554
Mailing Address - Country:US
Mailing Address - Phone:262-359-0044
Mailing Address - Fax:
Practice Address - Street 1:522 N NEW HAMPSHIRE ST SPC 9
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2843
Practice Address - Country:US
Practice Address - Phone:262-359-0044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty