Provider Demographics
NPI:1063634525
Name:JEFFERSON PARISH HOSPITAL SERVICE DISTRICT #1
Entity Type:Organization
Organization Name:JEFFERSON PARISH HOSPITAL SERVICE DISTRICT #1
Other - Org Name:WEST JEFFERSON HOME HEALTH AND HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:PHIPPS
Authorized Official - Last Name:DAPREMONT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-349-1610
Mailing Address - Street 1:1225 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3125
Mailing Address - Country:US
Mailing Address - Phone:504-349-1610
Mailing Address - Fax:504-349-8025
Practice Address - Street 1:4511 WESTBANK EXPY
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3120
Practice Address - Country:US
Practice Address - Phone:504-349-1610
Practice Address - Fax:504-349-8025
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFFERSON PARISH HOSPITAL SERVICE DISTRICT #1
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251G00000X251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1580571Medicaid