Provider Demographics
NPI:1487692380
Name:JEFFERSON HEALTHCARE CENTER LLC
Entity type:Organization
Organization Name:JEFFERSON HEALTHCARE CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:DELATTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-664-6697
Mailing Address - Street 1:2200 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70121-3822
Mailing Address - Country:US
Mailing Address - Phone:504-834-3144
Mailing Address - Fax:504-832-3909
Practice Address - Street 1:2200 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121-3822
Practice Address - Country:US
Practice Address - Phone:504-834-3144
Practice Address - Fax:504-832-3909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA858314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1510700Medicaid
LA1510700Medicaid