Organization
FRED JEFFERSON MEMORIAL HOME FOR BOYS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NIQUELLE DEONDREA LEWIS MA (EXECUTIVE DIRECTOR)
(310) 763-1660
Entity
Organization
Contact information
Practice address
152 W WALNUT ST STE 150, GARDENA, CA 90248-3146
(310) 763-1660
(310) 763-1660
Mailing address
152 W WALNUT ST STE 150, GARDENA, CA 90248-3146
(310) 763-1660
(310) 763-0357
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
197804218
CA
Other
Enumeration date
07/30/2007
Last updated
03/03/2020
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