NPIMap

Organization Active NPI

Fred Jefferson Memorial Home for Boys

  • Foster Care Agency
  • Gardena, CA
National Provider Identifier
1750824637
Registry record updated Mar 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foster Care AgencyTaxonomy code 253J00000X
Legal business name
FRED JEFFERSON MEMORIAL HOME FOR BOYS
Practice address
152 W Walnut St
Suite 150
Gardena, CA 90248-3141
Phone
(310) 763-1660
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
Foster Care Agency 253J00000X Primary

Addresses

Primary practice location

152 W Walnut St
Suite 150
Gardena, CA 90248-3141

Mailing address

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

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.

Locations

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

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": "1750824637",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "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"
        }
    ],
    "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": "253J00000X",
            "taxonomy_group": "",
            "desc": "Foster Care Agency",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gardena, 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.