Provider Demographics
NPI:1174664510
Name:EAST JEFFERSON COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:EAST JEFFERSON COMMUNITY HEALTH CENTER
Other - Org Name:EJCHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-CHAIR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-464-0032
Mailing Address - Street 1:11312 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123-1709
Mailing Address - Country:US
Mailing Address - Phone:504-464-0032
Mailing Address - Fax:504-466-3440
Practice Address - Street 1:11312 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:RIVER RIDGE
Practice Address - State:LA
Practice Address - Zip Code:70123-1709
Practice Address - Country:US
Practice Address - Phone:504-464-0032
Practice Address - Fax:504-466-3440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA80-001271261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1947652Medicaid
LA191826Medicare Oscar/Certification
LA5D956Medicare ID - Type UnspecifiedMEDICARE PART B