Provider Demographics
NPI:1790043123
Name:FAMILIES HELPING FAMILIES OF JEFFERSON
Entity Type:Organization
Organization Name:FAMILIES HELPING FAMILIES OF JEFFERSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:EDITH
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-888-9111
Mailing Address - Street 1:201 EVANS RD STE 102
Mailing Address - Street 2:
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-5230
Mailing Address - Country:US
Mailing Address - Phone:504-888-9111
Mailing Address - Fax:
Practice Address - Street 1:201 EVANS RD STE 102
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-5230
Practice Address - Country:US
Practice Address - Phone:504-888-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA253Z00000XMedicaid