| Fred Jefferson Memorial Home For Boys | |
|
152 W Walnut St Ste 150 Gardena CA 90248-3146 | |
| (310) 763-1660 | |
| (310) 763-1660 |
| Full Name | Fred Jefferson Memorial Home For Boys |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 152 W Walnut St Ste 150, Gardena, California |
| Authorized Official Name and Position | Niquelle Deondrea Lewis (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3107631660 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fred Jefferson Memorial Home For Boys 152 W Walnut St Ste 150 Gardena CA 90248-3146 Ph: (310) 763-1660 | Fred Jefferson Memorial Home For Boys 152 W Walnut St Ste 150 Gardena CA 90248-3146 Ph: (310) 763-1660 |
| NPI Number | 1659561223 |
|---|---|
| Provider Enumeration Date | 07/30/2007 |
| Last Update Date | 03/03/2020 |
| Certification Date | 03/03/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659561223 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 197804218 (California) | Primary |
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