Healthcare Provider Details

I. General information

NPI: 1124000773
Provider Name (Legal Business Name): JEFFERSON COMMUNITY HEALTH CARE CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4028 HIGHWAY 90 W
AVONDALE LA
70094-2622
US

IV. Provider business mailing address

4028 HIGHWAY 90 W
AVONDALE LA
70094-2622
US

V. Phone/Fax

Practice location:
  • Phone: 504-436-2223
  • Fax: 504-436-2224
Mailing address:
  • Phone: 504-436-2223
  • Fax: 504-436-2224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS STACEY MARIE LOVELL
Title or Position: BILLING OFFICE/CREDENTIALING
Credential:
Phone: 504-436-2223