Healthcare Provider Details

I. General information

NPI: 1427661354
Provider Name (Legal Business Name): THE CRADLE COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2020
Last Update Date: 08/29/2020
Certification Date: 08/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 E WINDSOR RD
GLENDALE CA
91205-2724
US

IV. Provider business mailing address

1510 E WINDSOR RD
GLENDALE CA
91205-2724
US

V. Phone/Fax

Practice location:
  • Phone: 323-662-0100
  • Fax: 323-662-0101
Mailing address:
  • Phone: 323-662-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: BRANDI JORDAN
Title or Position: OWNER
Credential: IBCLC
Phone: 323-662-0100