Provider Demographics
NPI:1992359772
Name:JEFFCARE
Entity Type:Organization
Organization Name:JEFFCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION DIRECTOR JEFFCARE
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-846-6983
Mailing Address - Street 1:3616 S I-10 SERVICE ROAD W.
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:504-846-6983
Mailing Address - Fax:504-838-5714
Practice Address - Street 1:5001 WEST BANK EXPRESSWAY
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:504-846-6983
Practice Address - Fax:504-838-5714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)