MEDICARE: CROWN HEALTHCARE AGENCY LLC

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1407709538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROWN HEALTHCARE AGENCY LLC

Provider Business Mailing Address
First Line	:	8153 TRUDY LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76120-5082
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8153 TRUDY LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76120-5082
Country	:	US
Telephone Number	:	714-579-9537
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOY ANWULI IWEKA
Credential	:
Telephone Number	:	714-579-9537

Provider Enumeration Date	:	02/18/2026
Last Update Date	:	03/10/2026

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