1528483849 NPI number — JEFFERSON COMMUNITY HEALTH CARE CENTERS, INC

Table of content: (NPI 1528483849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528483849 NPI number — JEFFERSON COMMUNITY HEALTH CARE CENTERS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFERSON COMMUNITY HEALTH CARE CENTERS, INC
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:
1528483849
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2490
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARRERO
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70073-2490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-437-8528
Provider Business Mailing Address Fax Number:
504-436-2224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5140 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFITTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70067-5256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-689-3300
Provider Business Practice Location Address Fax Number:
504-689-8223
Provider Enumeration Date:
02/24/2014

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
SHONDRA
Authorized Official Middle Name:
G
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
504-762-8931

Provider Taxonomy Codes

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

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

  • Identifier: 2337238 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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