Organization
JEFFERSON COMMUNITY HEALTH CARE CENTERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDOLPH J FISHER (INTERIM CEO)
(504) 328-0488
Entity
Organization
Contact information
Practice address
1855 AMES BLVD, MARRERO, LA 70072-3429
(504) 328-0488
(504) 328-0899
Mailing address
1855 AMES BLVD, MARRERO, LA 70072-3429
(504) 328-0488
(504) 328-0899
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1015199
—
LA
Enumeration date
11/01/2010
Last updated
11/17/2010
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