Organization · NPI-2

Fred Jefferson Moreno

Case Management · Gardena, CA

NPI number1962954024
StatusActive
Last updated in NPPESOct 25, 2016

Details

NPI
1962954024
Entity type
Organization (NPI-2)
Legal business name
Fred Jefferson Moreno
Organization subpart
No
Enumeration date
Oct 25, 2016
Last updated
Oct 25, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
251B00000X Case Management––Yes

Other names

  • Fred Jefferson M Aftercare (Doing Business As)

Practice location

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

Phone 310-763-1660

Mailing address

12981 Perris Blvd
Suite 107
Moreno Valley, CA 92553-4102

Phone 310-763-1660

Authorized official

Darryl Sewell
Cto/Program Director
3109290738

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