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General NPI Number Information
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NPI Number | 1598208696
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Entity Type | Organization
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Legal Business Name | OPTIMIST BOYS' HOME & RANCH, INC.
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Dates
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Enumeration Date | 11/22/2016
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 4900 SERRANIA AVE
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City | WOODLAND HILLS
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State | CA
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Zip | 91364-3301
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Country | US
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Telephone | 818-657-3123
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Fax | 818-347-1326
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Provider Business Mailing Address
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Address Line | 6957 N FIGUEROA ST
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City | LOS ANGELES
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State | CA
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Zip | 90042-1245
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Country | US
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Telephone | 323-443-3175
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Fax | 323-344-5124
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. TODD SOSNA
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Credential | PH.D.
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Telephone | 323-443-3101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | 198209477
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License Number State | CA
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