Fred Jefferson Memorial Home For Boys
Residential Treatment Facility, Emotionally Disturbed Children in Compton, CA. Organization (NPI-2).
NPI number1679016554
StatusActive
Last updated in NPPESMar 3, 2020
Details
- NPI
- 1679016554
- Entity type
- Organization (NPI-2)
- Legal business name
- Fred Jefferson Memorial Home For Boys
- Organization subpart
- No
- Enumeration date
- Nov 28, 2016
- Certification date
- Mar 3, 2020
- Last updated
- Mar 3, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | – | – | Yes |
Other names
- Fred Jefferson Memorial Home #1 (Other Name)
Practice location
1000 W 152nd StCompton, CA 90220-2821
Phone 310-763-1660 · Fax 310-763-0357
Mailing address
152 W Walnut StSuite 150
Gardena, CA 90248-3141
Phone 310-763-1660 · Fax 310-763-0357
Authorized official
Niquelle Deondrea Lewis
Executive Director
3107631660
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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