Provider Demographics
NPI:1962997569
Name:JEFFERSON COMMUNITY HEALTH CARE CENTERS, INC.
Entity type:Organization
Organization Name:JEFFERSON COMMUNITY HEALTH CARE CENTERS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JOELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:JESSIE SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-437-8523
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:504-371-8958
Mailing Address - Fax:504-328-0899
Practice Address - Street 1:2552 WILLIAMS BLVD
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-5538
Practice Address - Country:US
Practice Address - Phone:504-437-8523
Practice Address - Fax:504-436-3665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-26
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)