Provider Demographics
NPI:1518383785
Name:JEFFCARE
Entity Type:Organization
Organization Name:JEFFCARE
Other - Org Name:JEFFCARE EAST JEFFERSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DICHIRO DERBES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:504-838-5215
Mailing Address - Street 1:3616 S I 10 SERVICE RD W STE 200
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-1874
Mailing Address - Country:US
Mailing Address - Phone:504-838-5215
Mailing Address - Fax:504-838-5714
Practice Address - Street 1:3616 S I 10 SERVICE RD W
Practice Address - Street 2:SUITE 100
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1874
Practice Address - Country:US
Practice Address - Phone:504-838-5257
Practice Address - Fax:504-838-5714
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFFERSON PARISH HUMAN SERVICES AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-12
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2369105Medicaid