Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Organization
OPTIMIST BOYS' HOME & RANCH, INC.
Active
Organization
OPTIMIST BOYS' HOME & RANCH, INC.
Active
Other names
Pacific Lodge Campus
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BLYTHE COTTON MALING PH.D. (CHIEF EXECUTIVE OFFICER)
(323) 443-3101
Entity
Organization
Contact information
Practice address
4900 SERRANIA AVE, WOODLAND HILLS, CA 91364-3301
(818) 657-3123
(818) 347-1326
Mailing address
6957 N FIGUEROA ST, LOS ANGELES, CA 90042-1245
(323) 443-3175
(323) 344-5124
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
198209477
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00781
MEDI-CAL PROVIDER
CA
Enumeration date
11/22/2016
Last updated
07/08/2026
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up