Provider Demographics
NPI:1528483849
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:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHONDRA
Authorized Official - Middle Name:G
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:504-762-8931
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:504-437-8528
Mailing Address - Fax:504-436-2224
Practice Address - Street 1:5140 CHURCH ST
Practice Address - Street 2:
Practice Address - City:LAFITTE
Practice Address - State:LA
Practice Address - Zip Code:70067-5256
Practice Address - Country:US
Practice Address - Phone:504-689-3300
Practice Address - Fax:504-689-8223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2337238Medicaid