Provider Demographics
NPI:1821039983
Name:JEFFERSON PARISH HUMAN SERVICES AUTHORITY
Entity Type:Organization
Organization Name:JEFFERSON PARISH HUMAN SERVICES AUTHORITY
Other - Org Name:JEFFERSON PARISH HUMAN SERVICES AUTHORITY (EUNOIA CENTER)
Other - Org Type:Other Name
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
Mailing Address - Street 2:SUITE 200
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 1:5001 WESTBANK EXPY STE 200
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-2954
Practice Address - Country:US
Practice Address - Phone:504-349-3740
Practice Address - Fax:504-838-5714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1986704Medicaid
LA57533Medicare ID - Type Unspecified