Healthcare Provider Details

I. General information

NPI: 1326998758
Provider Name (Legal Business Name): CRANDALL HOME CARE OF ARIZONA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 W BROWN RD STE 3A1
MESA AZ
85201-3221
US

IV. Provider business mailing address

PO BOX 66539
ALBUQUERQUE NM
87193-6539
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-6683
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: STEVE TRACY
Title or Position: OWNER
Credential:
Phone: 505-266-6683