MEDICARE: JEFFERSON COMMUNITY HEALTH CARE CENTERS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)		LA

General Provider Information

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

Provider Business Mailing Address
First Line	:	PO BOX 2490
Second Line	:
City	:	MARRERO
State	:	LA
Zip	:	70073-2490
Country	:	US
Telephone Number	:	504-371-8958
Fax Number	:	504-328-0899

Provider Business Practice Location Address
First Line	:	2552 WILLIAMS BLVD
Second Line	:
City	:	KENNER
State	:	LA
Zip	:	70062-5538
Country	:	US
Telephone Number	:	504-437-8523
Fax Number	:	504-436-3665

Authorized Official
Title or Position	:	BILLING SPECIALIST
Name	:	JOELLE M JESSIE SKINNER
Credential	:
Telephone Number	:	504-437-8523

Provider Enumeration Date	:	06/26/2018
Last Update Date	:	07/17/2023

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