Provider Demographics
NPI:1811123664
Name:JEFFERSON COMMUNITY HEALTH CARE CENTERS, INC
Entity type:Organization
Organization Name:JEFFERSON COMMUNITY HEALTH CARE CENTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELPIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-340-2337
Mailing Address - Street 1:1855 AMES BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3429
Mailing Address - Country:US
Mailing Address - Phone:504-340-2337
Mailing Address - Fax:504-328-0899
Practice Address - Street 1:1855 AMES BLVD STE B
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3429
Practice Address - Country:US
Practice Address - Phone:504-340-2337
Practice Address - Fax:504-340-2376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-08
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1015199Medicaid
LA5CM83Medicare PIN