Organization
FRED JEFFERSON MEMORIAL HOME FOR BOYS
Active
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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