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Organization

OPTIMIST BOYS' HOME & RANCH, INC.

Active
Other names
Pacific Lodge Campus
Organization subpart
No

Provider details

NPI number
Authorized official
MR. TODD SOSNA 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
05/18/2023
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