1154747327 NPI number — JEFFCARE

Table of content: (NPI 1154747327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154747327 NPI number — JEFFCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFCARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154747327
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3616 S I 10 SERVICE RD W STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70001-1874
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-838-5215
Provider Business Mailing Address Fax Number:
504-838-5714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5001 WESTBANK EXPY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MARRERO
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70072-2954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-349-8833
Provider Business Practice Location Address Fax Number:
504-838-5714
Provider Enumeration Date:
03/12/2014

Additional Information

Authorized Official

Authorized Official Last Name:
DICHIRO DERBES
Authorized Official First Name:
ROSANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
504-838-5215

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2369393 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com