Organization
PACIFIC LODGE YOUTH SERVICES, INC
Active
Parent organization
PACIFIC LODGE YOUTH SERVICES
Organization subpart
Yes
Provider details
NPI number
Legal business name
PACIFIC LODGE YOUTH SERVICES
Authorized official
MRS. LISA E ALEGRIA (PRESIDENT CEO)
(818) 657-3104
Entity
Organization
Contact information
Practice address
22030 SHERMAN WAY STE 215, CANOGA PARK, CA 91303-1883
(818) 347-1577
Mailing address
22030 SHERMAN WAY STE 215, CANOGA PARK, CA 91303-1883
(818) 347-1577
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
—
Other
Enumeration date
02/10/2011
Last updated
02/10/2011
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