Healthcare Provider Details

I. General information

NPI: 1386728939
Provider Name (Legal Business Name): CRENSHAW ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 LONGWOOD AVE
LOS ANGELES CA
90016-1408
US

IV. Provider business mailing address

4032 WILSHIRE BLVD FL 6
LOS ANGELES CA
90010-3425
US

V. Phone/Fax

Practice location:
  • Phone: 323-933-1560
  • Fax: 323-936-9030
Mailing address:
  • Phone: 213-389-6900
  • Fax: 323-936-9030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number910000143
License Number StateCA

VIII. Authorized Official

Name: IRA DAVID FRIEDMAN
Title or Position: MANAGER
Credential:
Phone: 213-389-6900