NPIMap

Organization Active NPI

Fred Jefferson Memorial Home for Boys

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Compton, CA
National Provider Identifier
1679016554
Registry record updated Mar 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
FRED JEFFERSON MEMORIAL HOME FOR BOYS
Practice address
1000 W 152ND St
Compton, CA 90220-2821
Phone
(310) 763-1660
Fax
(310) 763-0357
NPI assigned
Nov 28, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Niquelle Deondrea Lewis, MA
Title
Executive Director
Phone
(310) 763-1660

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X Primary

Addresses

Primary practice location

1000 W 152ND St
Compton, CA 90220-2821

Mailing address

152 W Walnut St
Suite 150
Gardena, CA 90248-3141
Phone (310) 763-1660

Other names 1

  • Fred Jefferson Memorial Home #1 Other name

National Provider Directory

National Provider Directory
Tax ID family
Fred Jefferson Memorial Home for Boys7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1480291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583193600000",
    "number": "1679016554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "152 W WALNUT ST",
            "address_2": "SUITE 150",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902483141",
            "telephone_number": "310-763-1660",
            "fax_number": "310-763-0357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 W 152ND ST",
            "city": "COMPTON",
            "state": "CA",
            "postal_code": "902202821",
            "telephone_number": "310-763-1660",
            "fax_number": "310-763-0357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRED JEFFERSON MEMORIAL HOME FOR BOYS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-28",
        "last_updated": "2020-03-03",
        "certification_date": "2020-03-03",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "NIQUELLE",
        "authorized_official_middle_name": "DEONDREA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "310-763-1660",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fred Jefferson Memorial Home #1",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Compton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.