Provider Demographics
NPI:1912072521
Name:JAFORD ENTERPRISES
Entity Type:Organization
Organization Name:JAFORD ENTERPRISES
Other - Org Name:HIGHER GROUNDS PHARMACY MINISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEVELLE
Authorized Official - Middle Name:LIESA
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:225-291-0325
Mailing Address - Street 1:PO BOX 86028
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70879-6028
Mailing Address - Country:US
Mailing Address - Phone:225-291-0325
Mailing Address - Fax:225-291-0362
Practice Address - Street 1:4983 BLUEBONNET BLVD
Practice Address - Street 2:STE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3086
Practice Address - Country:US
Practice Address - Phone:225-291-0325
Practice Address - Fax:225-291-0362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA40583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1266311Medicaid
LA5583250001Medicare NSC