Croft Living Home, Inc.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

550002351 Issued in CA

Legal business name

CROFT LIVING HOME, INC.

Practice address

458 N Croft Ave
Los Angeles, CA 90048-2509

Phone

(323) 655-5060

Fax

(323) 651-1461

NPI assigned

Aug 15, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Shady Borna, P.A

Title

President

Phone

(323) 655-5060

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1376524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376524800000",
    "number": "1003249822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "458 N CROFT AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900482509",
            "telephone_number": "323-655-5060",
            "fax_number": "323-651-1461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "458 N CROFT AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900482509",
            "telephone_number": "323-655-5060",
            "fax_number": "323-651-1461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROFT LIVING HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-15",
        "last_updated": "2013-08-15",
        "status": "A",
        "authorized_official_last_name": "BORNA",
        "authorized_official_first_name": "SHADY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-655-5060",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "P.A"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "550002351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney Crocker
• Angelique Mone Crockett
• Devin James Crockett, AA, BA
• Alicia Crockham
• Lisa Crockom
• Eric Crombez, M.D.
• Joseph Garfield Crompton
• Hassani Cromwell
• Sara Cron
• Tanita Crone, LVN

• Clinic/Center in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.