# FRED JEFFERSON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fred Jefferson 142
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023551900
- **Authorized official:** DARRYL SEWELL (CHIEF ADMINISTRATIVE OFFICER)
- **Authorized official phone:** (310) 929-0738

## Contact information

- **Practice address:** 1448 E 142ND ST, COMPTON, CA 90222-3702
- **Practice address phone:** (310) 763-1660
- **Practice address fax:** (310) 763-0357
- **Mailing address:** 1448 E 142ND ST, COMPTON, CA 90222-3702
- **Mailing address phone:** (310) 929-0738
- **Mailing address fax:** (310) 763-0357

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | — | Yes |

## Other

- **Enumeration date:** 11/28/2016
- **Last updated:** 01/27/2017