Healthcare Provider Details

I. General information

NPI: 1962997569
Provider Name (Legal Business Name): JEFFERSON COMMUNITY HEALTH CARE CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2552 WILLIAMS BLVD
KENNER LA
70062-5538
US

IV. Provider business mailing address

PO BOX 2490
MARRERO LA
70073-2490
US

V. Phone/Fax

Practice location:
  • Phone: 504-437-8523
  • Fax: 504-436-3665
Mailing address:
  • Phone: 504-371-8958
  • Fax: 504-328-0899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateLA

VIII. Authorized Official

Name: JOELLE M JESSIE SKINNER
Title or Position: BILLING SPECIALIST
Credential:
Phone: 504-437-8523