FRED JEFFERSON MEMORIAL HOME FOR BOYS (NPI# 1750824637) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750824637 |
| Entity Type | Organization |
| Organization Name | FRED JEFFERSON MEMORIAL HOME FOR BOYS |
| Practice Address |
152 W Walnut St Suite 150 Gardena CA 90248-3141 |
| Practice Telephone | 3107631660 |
| Mailing Telephone | 3107631660 |
| Enumeration Date | 2016-11-28 |
| Last Update Date | 2020-03-03 |
| Authorized Official Name | NIQUELLE DEONDREA LEWIS (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 3107631660 |
| Authorized Official Credential | MA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 253J00000X | Foster Care Agency | Agencies |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679016554 | Fred Jefferson Memorial Home for Boys | Residential Treatment Facility, Emotionally Disturbed Children | 1000 W 152nd St, Compton, CA 90220-2821 | 2016-11-28 |
| 1598216707 | Fred Jefferson Memorial Home for Boys | Case Management | 1448 E 142nd St, Compton, CA 90222-3702 | 2016-10-24 |
| 1659561223 | Fred Jefferson Memorial Home for Boys | Community/Behavioral Health | 152 W Walnut St Ste 150, Gardena, CA 90248-3146 | 2007-07-30 |
| Street Address |
152 W WALNUT ST SUITE 150 |
| City | GARDENA |
| State | CA |
| Zip Code | 90248-3141 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962954024 | Fred Jefferson Moreno | Case Management | 152 W Walnut St, Suite 150, Gardena, CA 90248-3141 | 2016-10-25 |
| 1699218578 | Fred Jefferson Memorial | Foster Care Agency | 152 W Walnut St, Suite 150, Gardena, CA 90248-3141 | 2016-11-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215537543 | Gereine Mae Condino Datan | Nurse Practitioner | 500 W 190 St, Gardena, CA 90248 | 2020-10-27 |
| 1154811297 | Patrick Lee | Technician/Technologist | 18203 S. Western Ave Ste. 102, Torrance, CA 90248 | 2018-05-15 |
| 1386152445 | Ariana Felicitas Nieves | Behavioral Analyst | 870 W 190th St Ste 400, Gardena, CA 90248 | 2018-01-11 |
| 1265949606 | Jessica Keller | Behavioral Analyst | 879 W 190th St Suite 400, Gardena, CA 90248 | 2018-01-08 |
| 1265941199 | Jaimee E Munson | Behavioral Analyst | 18726 S. Western Ave St, #408, Gardena, CA 90248 | 2017-09-22 |
| 1922467349 | Fred Jefferson Memorial Homes | Substance Abuse Rehabilitation Facility | 152 W. Walnut, Suite 150, Gardena, CA 90248 | 2016-02-12 |
| 1922427442 | Shana Reilly | Behavioral Analyst | 18726 S. Western Ave., Suite 408, Los Angeles, CA 90248 | 2014-04-11 |
| 1588002216 | Aacres Ca, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 19300 S. Hamilton Ave, Ste 130, Gardena, CA 90248 | 2013-06-04 |
| 1093057598 | Aids Health Foundation | Pharmacist | 19300 S. Hamilton Ave., Ste 170, Gardena, CA 90248 | 2013-03-22 |
| 1245576594 | Hye Mi Kim | Behavioral Analyst | 18726 S. Western Ave.,#408, Gardena, CA 90248 | 2012-12-13 |
| Find all providers in zip 90248 | ||||
| Taxonomy Code | 253J00000X |
| Grouping | Agencies |
| Classification | Foster Care Agency |
| A Foster Care Agency is an agency that provides foster care as defined in the Code of Federal Regulations (CFR) as "24-hour substitute care for children outside their own homes." Foster care settings include, but are not limited to, nonrelative foster family homes, relative foster homes (whether payments are being made or not), group homes, emergency shelters, residential facilities, and pre-adoptive homes. |
| Notes: Source: Code Of Federal Regulations, Title 45, Volume 4, Part 1355, Section 57 [1/1/2008: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699218578 | Fred Jefferson Memorial | Foster Care Agency | 152 W Walnut St, Suite 150, Gardena, CA 90248-3141 | 2016-11-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972110088 | Wynspring Family Resource Center | Foster Care Agency | 2211 Park Towne Cir Ste 4, Sacramento, CA 95825-0414 | 2020-09-23 |
| 1285256438 | Latino Family Institute, Inc. | Foster Care Agency | 1501 W Cameron Ave Ste 240, West Covina, CA 91790-2733 | 2020-05-11 |
| 1356984264 | Garces Residential Care Services | Foster Care Agency | 7349 Milliken Ave # 140-223, Rancho Cucamonga, CA 91730-7435 | 2019-10-23 |
| 1265086094 | The Heart Matters Foster Family Agency | Foster Care Agency | 21935 Van Buren St Ste B-7, Grand Terrace, CA 92313-5652 | 2019-07-30 |
| 1346892072 | Nalcs | Foster Care Agency | 439 N Maclay Ave, San Fernando, CA 91340-2416 | 2019-07-12 |
| 1477105104 | Nalcs | Foster Care Agency | 1085 W Badillo St, Covina, CA 91722-4112 | 2019-07-12 |
| 1407408131 | Nalcs | Foster Care Agency | 322 W Katella Ave Ste 5-b, Orange, CA 92867-4759 | 2019-07-12 |
| 1316508542 | Nalcs | Foster Care Agency | 5400 Pomona Blvd, Los Angeles, CA 90022-1717 | 2019-06-27 |
| 1427519784 | Wayfinder Family Services | Foster Care Agency | 1045 Bonita Ave, La Verne, CA 91750-5109 | 2019-03-28 |
| 1437617784 | Koinonia Foster Homes, Inc. | Foster Care Agency | 6331 King Rd, Loomis, CA 95650-8801 | 2019-03-06 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.