Healthcare Provider Details

I. General information

NPI: 1780547703
Provider Name (Legal Business Name): CRANDALL HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 N MAIN ST
CLOVIS NM
88101-6656
US

IV. Provider business mailing address

PO BOX 66539
ALBUQUERQUE NM
87193-6539
US

V. Phone/Fax

Practice location:
  • Phone: 575-219-4111
  • 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: MANAGING MEMBER
Credential:
Phone: 505-266-6683