Provider Demographics
NPI:1215612742
Name:JEFFERSON COMMUNITY HEALTH CARE CENTERS, INC
Entity type:Organization
Organization Name:JEFFERSON COMMUNITY HEALTH CARE CENTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-206-7738
Mailing Address - Street 1:PO BOX 2490
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70073-2490
Mailing Address - Country:US
Mailing Address - Phone:504-437-8523
Mailing Address - Fax:
Practice Address - Street 1:1429 AMES BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-2867
Practice Address - Country:US
Practice Address - Phone:504-341-4006
Practice Address - Fax:504-436-3665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)