MEDICARE: PENNY LANE CENTERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency	191202002	CA
2	251S00000X	Community/Behavioral Health Agency	191202002	CA

General Provider Information

NPI Number	:	1962919589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENNY LANE CENTERS

Provider Business Mailing Address
First Line	:	15305 RAYEN ST
Second Line	:
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-5117
Country	:	US
Telephone Number	:	818-892-3423
Fax Number	:

Provider Business Practice Location Address
First Line	:	8855 NOBLE AVE RM 12
Second Line	:
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-5518
Country	:	US
Telephone Number	:	818-895-9620
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL INFO SYSTEMS DIRECTOR
Name	:	JULIE ANN CATANZARITE
Credential	:
Telephone Number	:	818-892-3423

Provider Enumeration Date	:	01/04/2018
Last Update Date	:	07/18/2019

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Directions to “PENNY LANE CENTERS ” Practice Location

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