Organization
FRED JEFFERSON MEMORIAL HOME FOR BOYS
Active
Other names
Fred Jefferson Memorial Home #1
Organization subpart
No
Provider details
NPI number
Authorized official
NIQUELLE DEONDREA LEWIS MA (EXECUTIVE DIRECTOR)
(310) 763-1660
Entity
Organization
Contact information
Practice address
1000 W 152ND ST, COMPTON, CA 90220-2821
(310) 763-1660
(310) 763-0357
Mailing address
152 W WALNUT ST, SUITE 150, GARDENA, CA 90248-3141
(310) 763-1660
(310) 763-0357
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/28/2016
Last updated
03/03/2020
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