Healthcare Provider Details

I. General information

NPI: 1417860206
Provider Name (Legal Business Name): CHANGING LIVESCROWN CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 S SEPULVEDA BLVD STE 1100
LOS ANGELES CA
90034-7090
US

IV. Provider business mailing address

3415 S SEPULVEDA BLVD STE 1100
LOS ANGELES CA
90034-7090
US

V. Phone/Fax

Practice location:
  • Phone: 424-500-6130
  • Fax:
Mailing address:
  • Phone: 424-500-6130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: IREANA PRICE
Title or Position: MANAGING MEMBER
Credential:
Phone: 424-500-6130