Organization
FRED JEFFERSON MORENO
Active
Other names
Fred Jefferson M Aftercare
Organization subpart
No
Provider details
NPI number
Authorized official
DARRYL SEWELL (CTO/PROGRAM DIRECTOR)
(310) 929-0738
Entity
Organization
Contact information
Practice address
152 W WALNUT ST, SUITE 150, GARDENA, CA 90248-3141
(310) 763-1660
Mailing address
12981 PERRIS BLVD, SUITE 107, MORENO VALLEY, CA 92553-4102
(310) 763-1660
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
10/25/2016
Last updated
10/25/2016
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