# JEFFERSON COMMUNITY HEALTH CARE CENTERS INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124000773
- **Authorized official:** MISS STACEY MARIE LOVELL (BILLING OFFICE/CREDENTIALING)
- **Authorized official phone:** (504) 436-2223

## Contact information

- **Practice address:** 4028 HIGHWAY 90 W, AVONDALE, LA 70094-2622
- **Practice address phone:** (504) 436-2223
- **Practice address fax:** (504) 436-2224
- **Mailing address:** 4028 HIGHWAY 90 W, AVONDALE, LA 70094-2622
- **Mailing address phone:** (504) 436-2223
- **Mailing address fax:** (504) 436-2224

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/18/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1447196 | — | LA |