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
NIQUELLE DEONDREA LEWIS MA (EXECUTIVE DIRECTOR)
(310) 763-1660
Entity
Organization
Contact information
Practice address
152 W WALNUT ST, SUITE 150, GARDENA, CA 90248-3141
(310) 763-1660
Mailing address
152 W WALNUT ST, SUITE 150, GARDENA, CA 90248-3141
(310) 763-1660
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
—
—
Other
Enumeration date
11/28/2016
Last updated
03/03/2020
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