MEDICARE: THE CRADLE COMPANY, 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	1041C0700X	Clinical Social Worker
2	174N00000X	Lactation Consultant (Non-RN)

General Provider Information

NPI Number	:	1427661354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CRADLE COMPANY, LLC

Provider Business Mailing Address
First Line	:	1510 E WINDSOR RD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-2724
Country	:	US
Telephone Number	:	323-662-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 E WINDSOR RD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-2724
Country	:	US
Telephone Number	:	323-662-0100
Fax Number	:	323-662-0101

Authorized Official
Title or Position	:	OWNER
Name	:	BRANDI JORDAN
Credential	:	IBCLC
Telephone Number	:	323-662-0100

Provider Enumeration Date	:	08/29/2020
Last Update Date	:	08/29/2020

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