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Jefferson Community Health Care Centers Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Westwego, LA

NPI 1942985437 · NPPES record last updated Jun 21, 2023

Key facts

NPI
1942985437
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
JEFFERSON COMMUNITY HEALTH CARE CENTERS INC
Practice address
435 S Jamie Blvd
Westwego, LA 70094-2860
Phone
(504) 341-4006
NPI assigned
Jun 21, 2023
Organization subpart
No

Authorized official

Name
Wanda Rose
Title
Cfo
Phone
(504) 206-7738

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 15

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 26

Medicare participation

Medicare fee-for-service enrollment
Enrolled in LA

Federally qualified health center certification: CCN 191135

Legal name
JEFFERSON COMMUNITY HEALTH CARE CENTERS, INC
Doing business as
INCLUSIVCARE-EMMETT GILBERT ELEMENTARY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 11, 2023
Last certification
Aug 11, 2023
Ownership / control type
For profit – corporation
Organization structure
Other · Non-profit
Incorporated
Jan 13, 2004 in LA
Enrollment address
435 S Jamie Blvd
Westwego, LA 70094-2860

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jeremy G Dumas
Individual 		Corporate Director
Chief Medical Director		 Jan 1, 2018
Lloyd Clark
Individual 		Other Aug 1, 2023
Audrey Parker
Individual 		Other Aug 1, 2023
Shone Webb
Individual 		Other Aug 1, 2023
Shondra G Williams
Individual 		Corporate Officer
Ceo		 Oct 17, 2013
Operational/Managerial Control
Ceo		 Oct 17, 2023

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20230814004060 LA Part a Provider - Federally Qualified Health Center (FQHC) 7911961115 Practice locations: Westwego, LA

National Provider Directory

Tax ID family
Inclusivcare (16 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Yes

Addresses

Primary practice location

435 S Jamie Blvd
Westwego, LA 70094-2860

Mailing address

PO Box 2490
Marrero, LA 70073-2490
Phone (504) 437-8523

Other names

  • Inclusivcare Doing business as

Other providers in Westwego, LA

All providers in Westwego, LA · Federally Qualified Health Center (FQHC) in Louisiana

Sources for this page

Verify at the official NPI Registry.