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General NPI Number Information
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NPI Number | 1174664510
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Entity Type | Organization
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Legal Business Name | EAST JEFFERSON COMMUNITY HEALTH CENTER
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11312 JEFFERSON HWY
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City | RIVER RIDGE
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State | LA
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Zip | 70123-1709
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Country | US
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Telephone | 504-464-0032
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Fax | 504-466-3440
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Provider Business Mailing Address
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Address Line | 11312 JEFFERSON HWY
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City | RIVER RIDGE
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State | LA
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Zip | 70123-1709
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Country | US
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Telephone | 504-464-0032
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Fax | 504-466-3440
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Authorized Official
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Title or Position | CO-CHAIR
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Name | MS. PATRICIA ANN BOWMAN
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Credential |
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Telephone | 504-464-0032
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 80-001271
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License Number State | LA
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