Healthcare Provider Details

I. General information

NPI: 1871416941
Provider Name (Legal Business Name): OPTIMIST BOYS' HOME AND RANCH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 SERRANIA AVE
WOODLAND HILLS CA
91364-3301
US

IV. Provider business mailing address

6957 N FIGUEROA ST
LOS ANGELES CA
90042-1245
US

V. Phone/Fax

Practice location:
  • Phone: 323-855-0143
  • Fax:
Mailing address:
  • Phone: 323-855-0861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: BLYTHE COTTON MALING
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 323-443-3101