# FRED JEFFERSON MEMORIAL HOME FOR BOYS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fred Jefferson Memorial Home \#1
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679016554
- **Authorized official:** NIQUELLE DEONDREA LEWIS MA (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (310) 763-1660

## Contact information

- **Practice address:** 1000 W 152ND ST, COMPTON, CA 90220-2821
- **Practice address phone:** (310) 763-1660
- **Practice address fax:** (310) 763-0357
- **Mailing address:** 152 W WALNUT ST, SUITE 150, GARDENA, CA 90248-3141
- **Mailing address phone:** (310) 763-1660
- **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:** 03/03/2020