Provider Demographics
NPI:1225894058
Name:LILY PAD LIVING OUTREACH
Entity Type:Organization
Organization Name:LILY PAD LIVING OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:SBRAGIA
Authorized Official - Suffix:
Authorized Official - Credentials:JD, SUDCC-II
Authorized Official - Phone:209-683-9300
Mailing Address - Street 1:2050 ANGELICO CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-7869
Mailing Address - Country:US
Mailing Address - Phone:209-683-9300
Mailing Address - Fax:
Practice Address - Street 1:333 N SAN JOAQUIN ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2954
Practice Address - Country:US
Practice Address - Phone:209-683-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder