Provider Demographics
NPI:1003353111
Name:JEFFERSON COMPREHENSIVE CARE SYSTEM, INC
Entity Type:Organization
Organization Name:JEFFERSON COMPREHENSIVE CARE SYSTEM, INC
Other - Org Name:NORTH LITTLE ROCK COMMUNITY HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-543-2300
Mailing Address - Street 1:PO BOX 1285
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71613-1285
Mailing Address - Country:US
Mailing Address - Phone:870-543-2311
Mailing Address - Fax:
Practice Address - Street 1:2525 WILLOW ST
Practice Address - Street 2:SUITE # 1
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-2213
Practice Address - Country:US
Practice Address - Phone:870-543-2380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFFERSON COMPREHENSIVE CARE SYSTEM, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)