Provider Demographics
NPI:1255977245
Name:JEFFERSON COMMUNITY HEALTH CARE CENTERS INC
Entity type:Organization
Organization Name:JEFFERSON COMMUNITY HEALTH CARE CENTERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHONDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-341-4006
Mailing Address - Street 1:4028 HIGHWAY 90 W
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:LA
Mailing Address - Zip Code:70094-2622
Mailing Address - Country:US
Mailing Address - Phone:543-341-4006
Mailing Address - Fax:504-267-4737
Practice Address - Street 1:3932 HIGHWAY 90 W
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:LA
Practice Address - Zip Code:70094-2648
Practice Address - Country:US
Practice Address - Phone:504-437-8523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy