Provider Demographics
NPI:1902930332
Name:PACIFIC LODGE YOUTH SERVICES
Entity Type:Organization
Organization Name:PACIFIC LODGE YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALEGRIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-657-3104
Mailing Address - Street 1:4900 SERRANIA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-3301
Mailing Address - Country:US
Mailing Address - Phone:818-657-3104
Mailing Address - Fax:818-347-0184
Practice Address - Street 1:4900 SERRANIA AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-3301
Practice Address - Country:US
Practice Address - Phone:818-657-3104
Practice Address - Fax:818-347-0184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)