Healthcare Provider Details

I. General information

NPI: 1053828673
Provider Name (Legal Business Name): PENNY LANE CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2018
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8817 LANGDON AVE
NORTH HILLS CA
91343-5004
US

IV. Provider business mailing address

15305 RAYEN ST
NORTH HILLS CA
91343-5117
US

V. Phone/Fax

Practice location:
  • Phone: 818-892-0778
  • Fax:
Mailing address:
  • Phone: 818-892-3423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number191202002
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number191202002
License Number StateCA

VIII. Authorized Official

Name: JULIE ANN CATANZARITE
Title or Position: CLINICAL INFO SYSTEMS DIRECTOR
Credential:
Phone: 818-892-3423