=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225894058
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LILY PAD LIVING OUTREACH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2024
-----------------------------------------------------
Last Update Date | 11/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 N SAN JOAQUIN ST
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95202-2954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-683-9300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1289
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95201-1289
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-683-9300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MRS. DEBRA LYNNE SBRAGIA
-----------------------------------------------------
Credential | JD, SUDCC-II
-----------------------------------------------------
Telephone | 209-683-9300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------