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General NPI Number Information
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NPI Number | 1417801648
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Entity Type | Organization
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Legal Business Name | JEFFERSON HOMES LLC
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Dates
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Enumeration Date | 02/24/2026
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Last Update Date | 02/24/2026
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Provider Practice Location Address
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Address Line | 2136 W 82ND ST
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City | LOS ANGELES
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State | CA
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Zip | 90047-2620
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Country | US
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Telephone | 818-963-0079
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Fax |
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Provider Business Mailing Address
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Address Line | 6201 W 87TH ST # 2681
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City | WESTCHESTER
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State | CA
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Zip | 90045-3901
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Country | US
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Telephone | 310-649-3919
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | CORNELL JEFFERSON
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Credential |
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Telephone | 818-963-0079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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