NPIMap

Organization Active NPI

Fred Jefferson Moreno

  • Case Management Agency
  • Gardena, CA
National Provider Identifier
1962954024
Registry record updated Oct 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
Legal business name
FRED JEFFERSON MORENO
Practice address
152 W Walnut St
Suite 150
Gardena, CA 90248-3141
Phone
(310) 763-1660
NPI assigned
Oct 25, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2016

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

Authorized official

Name
Darryl Sewell
Title
Cto/Program Director
Phone
(310) 929-0738

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X Primary

Addresses

Primary practice location

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

Mailing address

12981 Perris Blvd
Suite 107
Moreno Valley, CA 92553-4102
Phone (310) 763-1660

Other names 1

  • Fred Jefferson M Aftercare Doing business as

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": "1477353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477353600000",
    "number": "1962954024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12981 PERRIS BLVD",
            "address_2": "SUITE 107",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925534102",
            "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 MORENO",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-25",
        "last_updated": "2016-10-25",
        "status": "A",
        "authorized_official_last_name": "SEWELL",
        "authorized_official_first_name": "DARRYL",
        "authorized_official_title_or_position": "CTO/PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "310-929-0738"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fred Jefferson M Aftercare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Oct 25, 2016; 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.