Provider Demographics
NPI:1932230620
Name:PENNY LANE CENTER
Entity Type:Organization
Organization Name:PENNY LANE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENTIAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNNELL
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:HOLTBY
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:818-892-3423
Mailing Address - Street 1:15317 RAYEN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-5117
Mailing Address - Country:US
Mailing Address - Phone:818-892-3423
Mailing Address - Fax:818-893-4509
Practice Address - Street 1:15317 RAYEN ST
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-5117
Practice Address - Country:US
Practice Address - Phone:818-892-3423
Practice Address - Fax:818-893-4509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41129322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children