Healthcare Provider Details

I. General information

NPI: 1255977245
Provider Name (Legal Business Name): JEFFERSON COMMUNITY HEALTH CARE CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3932 HIGHWAY 90 W
AVONDALE LA
70094-2648
US

IV. Provider business mailing address

4028 HIGHWAY 90 W
AVONDALE LA
70094-2622
US

V. Phone/Fax

Practice location:
  • Phone: 504-302-1589
  • Fax: 504-267-4737
Mailing address:
  • Phone: 543-341-4006
  • Fax: 504-267-4737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHONDRA WILLIAMS
Title or Position: CEO
Credential:
Phone: 504-341-4006