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General NPI Number Information
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NPI Number | 1780547703
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Entity Type | Organization
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Legal Business Name | CRANDALL HOME CARE LLC
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 613 N MAIN ST
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City | CLOVIS
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State | NM
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Zip | 88101-6656
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Country | US
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Telephone | 575-219-4111
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 66539
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City | ALBUQUERQUE
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State | NM
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Zip | 87193-6539
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | STEVE TRACY
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Credential |
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Telephone | 505-266-6683
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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