Provider Demographics
NPI:1831158328
Name:MID-JEFFERSON EXTENDED CARE HOSPITAL
Entity type:Organization
Organization Name:MID-JEFFERSON EXTENDED CARE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLONDEAU
Authorized Official - Suffix:JR
Authorized Official - Credentials:JD
Authorized Official - Phone:225-938-1560
Mailing Address - Street 1:10124 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2725
Mailing Address - Country:US
Mailing Address - Phone:225-293-2700
Mailing Address - Fax:225-293-2730
Practice Address - Street 1:2600 HIGHWAY 365
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627
Practice Address - Country:US
Practice Address - Phone:409-726-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007921282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX452083Medicare Oscar/Certification