FRED JEFFERSON MEMORIAL HOME FOR BOYS (NPI# 1679016554) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679016554 |
| Entity Type | Organization |
| Organization Name | FRED JEFFERSON MEMORIAL HOME FOR BOYS |
| Other Organization Name | FRED JEFFERSON MEMORIAL HOME #1 |
| Practice Address |
1000 W 152nd St Compton CA 90220-2821 |
| Mailing Address |
152 W Walnut St Suite 150 Gardena CA 90248-3141 |
| Practice Telephone | 3107631660 |
| Practice Fax Number | 3107630357 |
| Mailing Telephone | 3107631660 |
| Mailing Fax Number | 3107630357 |
| 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 | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Fred Jefferson 152 | Doing Business As Name - Organization |
| Fred Jefferson Memorial Home #1 | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1750824637 | Fred Jefferson Memorial Home for Boys | Foster Care Agency | 152 W Walnut St, Suite 150, Gardena, CA 90248-3141 | 2016-11-28 |
| Street Address |
1000 W 152ND ST |
| City | COMPTON |
| State | CA |
| Zip Code | 90220-2821 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710490925 | Vivian Carolina Cariat | Interpreter | 2499 S. Wilmington Ave., Compton, CA 90220 | 2017-11-09 |
| 1366971632 | Bradlisia Dixon | Marriage & Family Therapist | 15116 S. Gibson Ave., East Rancho Dominguez, CA 90220 | 2017-06-08 |
| 1154701373 | Hilario Enrique Ramirez | Counselor | 901 W Victoria St Ste Fng, Compton, CA 90220 | 2015-06-03 |
| 1366841306 | Jessica Lisbet Diaz | Counselor | 901 W Victoria St. Suite F & G, Compton, CA 90220 | 2014-08-15 |
| 1134466709 | Compassion Care Center | Clinic/Center | 601 S. Arcacia Ave., Compton, CA 90220 | 2013-01-15 |
| 1881931905 | Compassion Care Center, Inc. | Clinic/Center | 900 W. Grenleaf Ave., Compton, CA 90220 | 2013-01-09 |
| 1699033902 | Crittenton Children Andfamily Services | Community/Behavioral Health | 2939 East Pacific Commerce Drive, Rancho Dominguez, CA 90220 | 2012-04-25 |
| 1285909226 | Talatu Peters Oyefeso | Physician Assistant | 701 S. Sante Fe Ave. #5194, Compton, CA 90220 | 2012-03-08 |
| 1881966307 | Nancy Urena | Counselor | 901 W. Victoria St Suite F & G, Compton, CA 90220 | 2012-01-30 |
| 1831470756 | Vanessa Guadalupe Sanchez | Case Manager/Care Coordinator | 1303 West Walnut Park Way, Compton, CA 90220 | 2011-09-06 |
| Find all providers in zip 90220 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356880967 | You Are The Difference Foundation | Residential Treatment Facility, Emotionally Disturbed Children | 700 S Burris Ave, Compton, CA 90221-3945 | 2017-02-15 |
| 1023551900 | Fred Jefferson | Residential Treatment Facility, Emotionally Disturbed Children | 1448 E 142nd St, Compton, CA 90222-3702 | 2016-11-28 |
| 1003006719 | Star View Cfs (teammates) | Residential Treatment Facility, Emotionally Disturbed Children | 1055 W Victoria St, Compton, CA 90220-5804 | 2007-07-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144820499 | Catholic Charities of The Diocese of Oakland | Residential Treatment Facility, Emotionally Disturbed Children | 3700 Dorisa Ave, Oakland, CA 94605-4941 | 2020-10-27 |
| 1922607944 | Inspire A Youth, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 7556 Avenida Baja, Riverside, CA 92509-3449 | 2020-10-21 |
| 1235736554 | Yvonne Dionne Robinson | Residential Treatment Facility, Emotionally Disturbed Children | 1223 E Helmick St, Carson, CA 90746-3163 | 2020-10-09 |
| 1740897784 | Paradise Adolescent Home, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 602 Woodlark Dr, Suisun City, CA 94585-2244 | 2020-09-24 |
| 1548877657 | T & T House of Champions | Residential Treatment Facility, Emotionally Disturbed Children | 2115 High St, Oakland, CA 94601-4335 | 2020-09-23 |
| 1902412182 | Paradise Adolescent Home, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 136 Valdivia Cir, San Ramon, CA 94583-2228 | 2020-09-22 |
| 1073128492 | Samuel Campbell Jr. | Residential Treatment Facility, Emotionally Disturbed Children | 4200 Crescent Rock Ln, Bakersfield, CA 93311-2860 | 2020-09-11 |
| 1336753433 | Aaron's Boys Home | Residential Treatment Facility, Emotionally Disturbed Children | 5805 Capistrano Ave Ste E, Atascadero, CA 93422-7218 | 2020-09-04 |
| 1699389452 | Millie's Youth Services, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 2512 Havenscourt Blvd, Oakland, CA 94605-1935 | 2020-08-31 |
| 1538779871 | Hidden Treasures Foundation, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 1240 W 13th Ave, Escondido, CA 92025-5560 | 2020-08-02 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on FRED JEFFERSON MEMORIAL HOME FOR BOYS.
| 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.