Healthcare Provider Details

I. General information

NPI: 1154747327
Provider Name (Legal Business Name): JEFFCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 WESTBANK EXPY SUITE 100
MARRERO LA
70072-2954
US

IV. Provider business mailing address

3616 S I 10 SERVICE RD W STE 200
METAIRIE LA
70001-1874
US

V. Phone/Fax

Practice location:
  • Phone: 504-349-8833
  • Fax: 504-838-5714
Mailing address:
  • Phone: 504-838-5215
  • Fax: 504-838-5714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROSANNA DICHIRO DERBES
Title or Position: EXECUTIVE DIRECTOR
Credential: PSY.D
Phone: 504-838-5215